Resection of complex pancreatic injuries: benchmarking postoperative morbidity using the accordion severity grading system

Abstract

Background: This study benchmarked the severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing resection for severe pancreatic injuries. Methods: A prospective database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. 130 patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy (PD) n=20, distal pancreatectomy n=110), including 30 who had damage control laparotomy (DCL) and later definitive surgery. 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. 19 patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had RTS <7.8, were shocked on admission, had grade 5 pancreatic injuries with vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a 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. Conclusion: ASGS-assessed morbidity after pancreatic resection for trauma was high. This detailed outcome analysis serves as a reference for future institutional comparisons.