Abstract
Background: Pancreatic trauma results in significant morbidity and mortality. Few studies have investigated the postoperative prognostic factors in patients with pancreatic trauma after surgery. Methods: A retrospective study was conducted on 152 consecutive patients with pancreatic trauma who underwent surgery in Jinling Hospital, a national referral trauma center in China, from January 2012 to December 2019. Univariate and binary logistic regression analyses were performed to identify the perioperative clinical parameters that may affect the morbidity of the patients. Results: A total of 184 patients with pancreatic trauma were admitted during the study period, and 32 patients with nonoperative management were excluded. The remaining 152 patients underwent laparotomy due to pancreatic trauma. Sixty-four patients were referred from other centers due to postoperative complications. Abdominal bleeding caused by pancreatic leakage ( 10 of all deaths) and severe intra-abdominal infection (12 of all deaths) were the major causes of mortality. Twenty-eight (77.8%) of the 36 patients who had damage control laparotomy survived. Univariate analysis showed that age, hemodynamic status, and injury severe score (ISS) as well as postoperative serum levels of C-reactive protein (CRP), procalcitonin, albumin and creatinine and the volume of intraoperative blood transfusion had significant effects on the mortality ( P <0.05). Binary logistic regression analysis showed that the independent risk factors for prognosis after pancreatic trauma surgery were age ( P =0.012), preoperative hemodynamic instability ( P =0.018), postoperative CPR ≥154 mg/L ( P =0.016), and postoperative serum creatinine ≥177 μmol/L ( P =0.017). The 30-day mortality rate was 15.8%. Conclusions: In this single-center retrospective study, we first demonstrated that severe intra-abdominal infection and bleeding were the major factors affecting the prognosis of patients with pancreatic trauma after surgery. Preoperative hemodynamic instability, severe postoperative inflammation (CRP ≥154 mg/L) and acute renal failure (creatinine ≥177 μmol/L) were associated with a significant risk of mortality.
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