Surgery · 2026
Outcomes following left-sided pancreatectomy management with and without splenectomy for major pancreatic injury.
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Tabibian Daniel, Tabibian Kevin, Chaturvedi Arjun, Balian Jeffrey, Coaston Troy, Lai Owen, Benharash Peyman, Tran Zachary
Аннотация
BACKGROUND: Traumatic pancreatic injuries carry significant mortality and often involve splenectomy because of the anatomic proximity of the spleen. However, current trauma guidelines provide no evidence-based recommendation for or against routine splenectomy at the time of left-sided pancreatectomy, instead advocating an individualized approach. Contemporary data comparing left-sided pancreatectomy management with splenectomy and without splenectomy (nonsplenectomy) remain limited. We evaluated perioperative outcomes following splenectomy versus nonsplenectomy left-sided pancreatectomy in a national trauma cohort.
METHODS: The 2018-2021 Trauma Quality Improvement Program was queried for patients ≥16 years with pancreatic injury undergoing left-sided pancreatectomy. Those with concomitant splenic injury were excluded, and records were stratified by whether splenectomy was performed. The primary end point was in-hospital mortality. Secondary outcomes included major adverse events, individual complications, intensive care unit admission, and intensive care unit length of stay. Multivariable regression models assessed the independent association between splenectomy and left-sided pancreatectomy and outcomes.
RESULTS: Of 758 patients, 393 (51.8%) underwent splenectomy, and 365 (48.2%) underwent nonsplenectomy. Splenectomy patients had lower Traumatic Injury Machine Learning-based scores (0.05 vs 0.07; P < .001) and shorter time to operation (64 vs 519 minutes; P < .001). Following risk adjustment, splenectomy was not associated with differences in in-hospital mortality (adjusted odds ratio, 0.81; 95% confidence interval, 0.47-1.38) or major adverse events (adjusted odds ratio, 0.97; 95% confidence interval, 0.68-1.39). Rates of cardiac, respiratory, thromboembolic, infectious, and renal complications were comparable between cohorts, as were intensive care unit admission and length of stay. Utilization remained stable throughout the study period (nptrend, 0.18).
CONCLUSION: Left-sided pancreatectomy with splenectomy was not associated with differences in postoperative mortality or major complications compared with nonsplenectomy left-sided pancreatectomy. These findings support individualized operative decision-making, whereas long-term septic complications and follow-up warrant further investigation.
METHODS: The 2018-2021 Trauma Quality Improvement Program was queried for patients ≥16 years with pancreatic injury undergoing left-sided pancreatectomy. Those with concomitant splenic injury were excluded, and records were stratified by whether splenectomy was performed. The primary end point was in-hospital mortality. Secondary outcomes included major adverse events, individual complications, intensive care unit admission, and intensive care unit length of stay. Multivariable regression models assessed the independent association between splenectomy and left-sided pancreatectomy and outcomes.
RESULTS: Of 758 patients, 393 (51.8%) underwent splenectomy, and 365 (48.2%) underwent nonsplenectomy. Splenectomy patients had lower Traumatic Injury Machine Learning-based scores (0.05 vs 0.07; P < .001) and shorter time to operation (64 vs 519 minutes; P < .001). Following risk adjustment, splenectomy was not associated with differences in in-hospital mortality (adjusted odds ratio, 0.81; 95% confidence interval, 0.47-1.38) or major adverse events (adjusted odds ratio, 0.97; 95% confidence interval, 0.68-1.39). Rates of cardiac, respiratory, thromboembolic, infectious, and renal complications were comparable between cohorts, as were intensive care unit admission and length of stay. Utilization remained stable throughout the study period (nptrend, 0.18).
CONCLUSION: Left-sided pancreatectomy with splenectomy was not associated with differences in postoperative mortality or major complications compared with nonsplenectomy left-sided pancreatectomy. These findings support individualized operative decision-making, whereas long-term septic complications and follow-up warrant further investigation.