The Journal of surgical research · 2026
Outcomes in Early versus Delayed Trauma Pancreaticoduodenectomies in Gunshot Wounds to the Pancreas.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
van Zon Veerle P C, Panossian Vahe S, Nzenwa Ikemsinachi C, Arnold Suzanne C, Lagazzi Emanuele, Hwabejire John O, Velmahos George C, Parks Jonathan J
Аннотация
INTRODUCTION: Pancreaticoduodenectomy (PD) for traumatic injuries remains a rare procedure with high mortality. This study aims to compare early versus delayed PD in trauma patients with gunshot wound (GSW) injury to the pancreas.
METHODS: We identified patients in the American College of Surgeons Trauma Quality Improvement Program database (2010-2020) with pancreatic injuries due to GSW undergoing an exploratory laparotomy and a PD. We stratified them into early (≤6 h) and late (>6 h) PD. Hemodynamical instability was defined by shock index (heart rate/systolic blood pressure)>1.0. The primary outcome was in-hospital mortality until discharge, whereas secondary outcomes were hospital length of stay, intensive care unit length of stay, ventilator days, and hospital complications.
RESULTS: A total of 96 patients were included. The median age was 30 y, 91.7% were males, and the median injury severity score was 25. Overall, 64% had early PD and 36% had a late PD. Significantly more liver injuries were observed in the early PD group compared to the late PD group (77.0% versus 51.4%, P = 0.01). The late PD group had a higher percentage of vena cava injuries compared to the early PD group (37.1% versus 18.0%, P = 0.037). The overall mortality was 20.8%. Mortality was higher in early PD compared to late PD (27.8% versus 4.3%, respectively; P = 0.024). Among survivors, patients undergoing late PD had a higher percentage of acute kidney failure compared to those undergoing an early PD (27.3% and 9.3%, respectively; P = 0.039). Early PD is independently associated with increased odds of in-hospital mortality (odds ratio 8.3 [95% confidence interval: 1.62-41.92]).
CONCLUSIONS: In this national analysis, delayed PD for GSW to the pancreas following initial stabilization was associated with lower mortality compared to PD performed within 6 h of presentation. These findings support a staged approach when clinically feasible.
METHODS: We identified patients in the American College of Surgeons Trauma Quality Improvement Program database (2010-2020) with pancreatic injuries due to GSW undergoing an exploratory laparotomy and a PD. We stratified them into early (≤6 h) and late (>6 h) PD. Hemodynamical instability was defined by shock index (heart rate/systolic blood pressure)>1.0. The primary outcome was in-hospital mortality until discharge, whereas secondary outcomes were hospital length of stay, intensive care unit length of stay, ventilator days, and hospital complications.
RESULTS: A total of 96 patients were included. The median age was 30 y, 91.7% were males, and the median injury severity score was 25. Overall, 64% had early PD and 36% had a late PD. Significantly more liver injuries were observed in the early PD group compared to the late PD group (77.0% versus 51.4%, P = 0.01). The late PD group had a higher percentage of vena cava injuries compared to the early PD group (37.1% versus 18.0%, P = 0.037). The overall mortality was 20.8%. Mortality was higher in early PD compared to late PD (27.8% versus 4.3%, respectively; P = 0.024). Among survivors, patients undergoing late PD had a higher percentage of acute kidney failure compared to those undergoing an early PD (27.3% and 9.3%, respectively; P = 0.039). Early PD is independently associated with increased odds of in-hospital mortality (odds ratio 8.3 [95% confidence interval: 1.62-41.92]).
CONCLUSIONS: In this national analysis, delayed PD for GSW to the pancreas following initial stabilization was associated with lower mortality compared to PD performed within 6 h of presentation. These findings support a staged approach when clinically feasible.