title: Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification.
abstract: OBJECTIVE
  To benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries.
  
  
  METHODS
  A prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy,n= 20, distal pancreatectomy,n= 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni- and multivariate logistic regression analysis was applied.
  
  
  RESULTS
  Overall 238 complications occurred in 95 (73%) patients of which 73% were ASGS grades 3-6. Nineteen patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score (RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy (PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS < 7.8, shock on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection (PD) were significant.
  
  
  CONCLUSIONS
  This ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.
authors.affiliation: Jake E Krige, Eduard Jonas, Urda K Kotze, Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Observatory, Cape Town 7925, South Africa.
authors.forename: Jake E
authors.initials: JE
authors.lastname: Krige
authors.affiliation: Jake E Krige, Eduard Jonas, Urda K Kotze, Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Observatory, Cape Town 7925, South Africa.
authors.forename: Eduard
authors.initials: E
authors.lastname: Jonas
authors.affiliation: Jake E Krige, Eduard Jonas, Urda K Kotze, Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Observatory, Cape Town 7925, South Africa.
authors.forename: Sandie R
authors.initials: SR
authors.lastname: Thomson
authors.affiliation: Jake E Krige, Eduard Jonas, Urda K Kotze, Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Observatory, Cape Town 7925, South Africa.
authors.forename: Urda K
authors.initials: UK
authors.lastname: Kotze
authors.affiliation: Jake E Krige, Eduard Jonas, Urda K Kotze, Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Observatory, Cape Town 7925, South Africa.
authors.forename: Mashiko
authors.initials: M
authors.lastname: Setshedi
authors.affiliation: Jake E Krige, Eduard Jonas, Urda K Kotze, Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Observatory, Cape Town 7925, South Africa.
authors.forename: Pradeep H
authors.initials: PH
authors.lastname: Navsaria
authors.affiliation: Jake E Krige, Eduard Jonas, Urda K Kotze, Surgical Gastroenterology Unit, Department of Surgery, University of Cape Town Health Sciences Faculty, Observatory, Cape Town 7925, South Africa.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nicol
keywords: Accordion classification; Complications; Injury; Pancreas