title: Management of pancreatic injuries during damage control surgery: an observational outcomes analysis of 79 patients treated at an academic Level 1 trauma centre.
abstract: BACKGROUND
  This study evaluated factors influencing mortality in a large cohort of patients who sustained pancreatic injuries and underwent DCS.
  
  
  METHODS
  A prospective database of consecutive patients with pancreatic injuries treated at a Level 1 academic trauma centre was reviewed to identify those who underwent DCS between 1995 and 2014.
  
  
  RESULTS
  Seventy-nine (71 men, median age: 26 years, range 16-73 years, gunshot wounds = 62, blunt = 14, stab = 3) patients with pancreatic injuries (35 proximal, 44 distal) had DCS. Fifty-nine (74.7 %) patients had AAST grade 3, 4 or 5 pancreatic injuries. The 79 patients had a total of 327 associated injuries (mean: 3 per patient, range 0-6) and underwent a total of 187 (range 1-7) operations. Vascular injuries (60/327, 18.3 %) occurred in 41 patients. Twenty-seven (34.2 %) patients died without having a second operation. The remaining 52 patients had two or more laparotomies (range 2-7). Overall 28 (35 %) patients underwent a pancreatic resection either during DCS (n = 18) or subsequently as a secondary procedure (n = 10) including a Whipple (n = 6) when stable. Overall 43 (54.4 %) patients died. Mortality was related to associated vascular injuries overall (p < 0.01), major visceral venous injuries (p < 0.01) and combined vascular and total number of associated organs injured (p < 0.04).
  
  
  CONCLUSIONS
  Despite the magnitude of their combined injuries and the degree of physiological insult, DCS salvaged 45 % of critically injured patients who later underwent definitive pancreatic surgery. Mortality correlated with associated vascular injuries overall, major visceral venous injuries and the combination of vascular plus the total number of associated organs injured.
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa. jej.krige@uct.ac.za.|Surgical Gastroenterology Unit, Groote Schuur Hospital, Observatory, Cape Town, South Africa. jej.krige@uct.ac.za.
authors.forename: J E J
authors.initials: JEJ
authors.lastname: Krige
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, South Africa.|Surgical Gastroenterology Unit, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
authors.forename: U K
authors.initials: UK
authors.lastname: Kotze
authors.affiliation: Department of Medicine, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Setshedi
authors.affiliation: Department of Surgery, University of Cape Town Health Sciences Faculty, Anzio Road, Observatory, Cape Town, 7925, 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, Anzio Road, Observatory, Cape Town, 7925, 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 / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods; D011446:Prospective Studies; D013019:South Africa; D014193:Trauma Centers; D055815:Young Adult
keywords: Damage control surgery; Pancreas; Trauma