title: Morbidity and mortality after distal pancreatectomy for trauma: a critical appraisal of 107 consecutive patients undergoing resection at a Level 1 Trauma Centre.
abstract: BACKGROUND
  This study evaluated 30-day morbidity and mortality and assessed pancreas-specific complications in patients with major pancreatic injuries who underwent a distal pancreatectomy.
  
  
  METHODS
  Records of 107 consecutive patients who underwent a distal pancreatectomy at a Level 1 Trauma Centre in Cape Town between January 1982 and December 2011 were reviewed. Primary endpoints were postoperative morbidity and death. Complications were graded according to the Clavien-Dindo severity classification and the International Study Group of Pancreatic Surgery (ISGPS) definitions.
  
  
  RESULTS
  A total of 107 patients [94 men, median age 26, median RTS 7.8, 69 penetrating injuries (63 gunshot wounds, 6 stabs wounds), 38 blunt injuries] underwent distal pancreatectomy. Overall mortality was 12%, 16% for gunshot injuries, 8% for blunt trauma and 0% in patients who had stab wounds. Eighty patients had a post-operative complication. A pancreatic leak (n=26) was the most common pancreatic related complication. Median postoperative stay in 28 patients with no or grade I complications was 9 days; in 11 patients with grade II complications was 18 days; in 14 grade IIIa, 31 days; in 19 grade IIIb, 38 days; in 8 grade IVa, 33 days in 14 grade IVb, and in 13 grade V the duration of postoperative stay was 14±39.4 days.
  
  
  CONCLUSIONS
  Overall mortality for distal pancreatectomy was 12%. Pancreatic leak was a common cause of morbidity. Length of hospitalisation increased with increasing Clavien-Dindo severity grading. There was a significant difference in the duration of hospitalisation in patients with no or grade I complications compared to those with grade II-IV injuries (p<0.05).
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Cape Town, South Africa; Surgical Gastroenterology Unit, Cape Town, South Africa. Electronic address: jej.krige@uct.ac.za.
authors.forename: J E J
authors.initials: JE
authors.lastname: Krige
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Cape Town, South Africa; Surgical Gastroenterology Unit, Cape Town, South Africa.
authors.forename: U K
authors.initials: UK
authors.lastname: Kotze
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Cape Town, South Africa; Trauma Centre, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
authors.forename: A J
authors.initials: AJ
authors.lastname: Nicol
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Cape Town, South Africa; Trauma Centre, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
authors.forename: P H
authors.initials: PH
authors.lastname: Navsaria
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D009104:Multiple Trauma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*
keywords: Distal pancreatectomy; Injury; Morbidity; Mortality; Pancreas