title: Outcomes following operative vs. non-operative management of blunt traumatic pancreatic injuries: a retrospective multi-institutional study.
abstract: BACKGROUND
  Traumatic pancreatic injuries are rare, and guidelines specifying management are controversial and difficult to apply in the acute clinical setting. Due to sparse data on these injuries, we carried out a retrospective review to determine outcomes following surgical or non-surgical management of traumatic pancreatic injuries. We hypothesize a higher morbidity and mortality rate in patients treated surgically when compared to patients treated non-surgically.
  
  
  METHODS
  We performed a retrospective review of data from four trauma centers in New York from 1990-2014, comparing patients who had blunt traumatic pancreatic injuries who were managed operatively to those managed non-operatively. We compared continuous variables using the Mann-WhitneyUtest and categorical variables using the chi-square and Fisher's exact tests. Univariate analysis was performed to determine the possible confounding factors associated with mortality in both treatment groups.
  
  
  RESULTS
  Twenty nine patients were managed operatively and 32 non-operatively. There was a significant difference between the operative and non-operative groups in median age (37.0 vs. 16.2 years,P= 0.016), grade of pancreatic injury (grade I; 30.8 vs. 85.2%,Pvalue for all comparisons <0.0001), median injury severity score (ISS) (16.0 vs. 4.0,P= 0.002), blood transfusion (55.2 vs. 15.6%,P= 0.0012), other abdominal injuries (79.3 vs. 38.7%,P= 0.0014), pelvic fractures (17.2 vs. 0.00%,P= 0.020), intensive care unit (ICU) admission (86.2 vs. 50.0%,P= 0.003), median length of stay (LOS) (16.0 vs. 4.0 days,P<0.0001), and mortality (27.6 vs. 3.1%,P= 0.010).
  
  
  CONCLUSIONS
  Patients with traumatic pancreatic injuries treated operatively were more severely injured and suffered greater complications than those treated non-operatively. The greater morbidity and mortality associated with these patients warrants further study to determine optimal triage strategies and which subset of patients is likely to benefit from surgery.
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.|Pancreas Disease Center, Northwell Health, Manhasset, NY USA.
authors.forename: Poppy
authors.initials: P
authors.lastname: Addison
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.|Pancreas Disease Center, Northwell Health, Manhasset, NY USA.
authors.forename: Toni
authors.initials: T
authors.lastname: Iurcotta
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.|Pancreas Disease Center, Northwell Health, Manhasset, NY USA.
authors.forename: Leo I
authors.initials: LI
authors.lastname: Amodu
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Crandall
authors.affiliation: Department of Biostatistics, Feinstein Institute for Medical Research, Manhasset, NY USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Akerman
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Galvin
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Glazer
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Christopherson
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Prince
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bank
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sorrentino
authors.affiliation: Pancreas Disease Center, Northwell Health, Manhasset, NY USA.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Cagliani
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.|Pancreas Disease Center, Northwell Health, Manhasset, NY USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nicastro
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.|Pancreas Disease Center, Northwell Health, Manhasset, NY USA.
authors.forename: Gene
authors.initials: G
authors.lastname: Coppa
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.|Pancreas Disease Center, Northwell Health, Manhasset, NY USA.
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.affiliation: Department of Surgery, Hofstra-Northwell School of Medicine, Hempstead, NY USA.|Pancreas Disease Center, Northwell Health, Manhasset, NY USA.|Northwell Health, 900 Northern Boulevard, Suite 150, Great Neck, NY 11020 USA.
authors.forename: Horacio L Rodriguez
authors.initials: HLR
authors.lastname: Rilo
keywords: Injury; Management; Non-operative; Operative; Pancreas; Trauma