title: Early pancreatic dysfunction after resection in trauma: An 18-year report from a Level I trauma center.
abstract: Early pancreatic dysfunction after resection in trauma has not been well characterized. The objective of this study was to examine the incidence and clinical impact of new-onset endocrine and exocrine dysfunction after pancreatic resection for trauma.
  
  
  
  All patients sustaining a pancreatic injury from 1996 to 2013 were identified. Patients with preinjury diabetes were excluded. Survivors were divided into three groups according to the extent of anatomic resection-distal, proximal, or total pancreatectomy. Clinical demographics and outcome data were abstracted. Blood glucose levels, hemoglobin A1c, and insulin requirements were used to assess endocrine pancreatic function. Reported steatorrhea, diarrhea, or supplemental pancreatic enzyme requirements were used to assess exocrine pancreatic function.
  
  
  
  During the study period, 331 pancreatic injuries were identified, of which 109 (33%) required resection and 84 survived to hospital discharge. Four were excluded. Of 80 cases analyzed, 73 (91%) underwent distal pancreatectomy, 7 (9%) proximal pancreatectomy, and none a total pancreatectomy. The distal resection group was predominantly male (88%), median age 24 years, and mean BMI 27 (kg/m). Thirty-eight (52%) required insulin postoperatively, with the greatest proportion (47%) requiring insulin for ≤1 day; no patients were discharged on insulin. The proximal resection group was predominantly male (86%), median age 31 years, and mean BMI 32 (kg/m). Six of seven required insulin postoperatively and two of seven were insulin dependent at time of hospital discharge. For both distal and proximal resections, none had evidence of exocrine dysfunction or received pancreatic enzyme supplementation at discharge.
  
  
  
  Exocrine dysfunction after distal or proximal pancreatectomy for trauma is rare. The incidence of early onset endocrine dysfunction after traumatic distal pancreatectomy is also rare; however, it can be seen after proximal resection.
  
  
  
  Therapeutic study, level IV.
authors.affiliation: Division of Trauma and Surgical Critical Care, Departments of Surgery (N.M., K.I., R.B., E. Benjamin, L.L., K.M., D.D.) and Endocrinology (E. Beale), Los Angeles County and University of Southern California Medical Center, Los Angeles, California.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mansfield
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Regan
authors.initials: R
authors.lastname: Berg
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Beale
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D010188:Exocrine Pancreatic Insufficiency / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D010179:Pancreas / Q000293:injuries* / Q000503:physiopathology*; D010180:Pancreatectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors; D014193:Trauma Centers; D016896:Treatment Outcome