V.P. Van Zon1, V. Panossian1, I.C. Nzenwa1, M. Bartek1, J. Ng-Kamstra1, M. DeWane1, C.M. Luckhurst1, K.H. Albutt1, J.J. Parks1, C.N. Paranjape1, H.M. Kaafarani1, G. Velmahos1, J.O. Hwabejire1 1Massachusetts General Hospital, Division Of Trauma, Emergency Surgery & Surgical Critical Care, Boston, MA, USA
Introduction: Blunt pancreatic trauma is a rare but serious condition, accounting for only 0.2% of all blunt trauma cases. Despite its low incidence, it is associated with significant morbidity and mortality, with rates as high as 23.4%. There is a lack of sufficient studies focusing on clinical outcomes in older adults with blunt pancreatic trauma. Therefore, this study aims to identify predictors of clinical outcomes in this population.
Methods: The American College of Surgery Trauma Quality Improvement Program (ACS-TQIP) database, years 2010 to 2020, was used. Patients aged 65 years and older who sustained blunt pancreatic injury were included. The primary outcome was in-hospital mortality. Secondary outcomes were hospital length of stay, composite complications, and complications. Hemodynamic stability was defined as age × (systolic blood pressure/heart rate) < 50. Logistic regression was performed to assess the predictors of mortality.
Results:A total of 890 patients were included, with a median age of 72 years; 52.8% were male. Among non-survivors, there was a higher incidence of liver, aortic, vena cava, diaphragm, heart, and lung injuries (all p < 0.001), small bowel injury (p = 0.003), pneumothorax (p = 0.008), and rib fractures (p = 0.047). Survivors were more likely to be smokers (p = 0.002), have a lower rate of hemorrhage control laparotomy (p = 0.001), and be hemodynamically stable (p < 0.001). Pancreatic resection was performed in 3.8% of patients, with drainage procedures and ERCP each performed in 0.8%. The majority of patients (94.6%) did not undergo pancreatic surgery. Exploratory laparotomy was conducted in 13%. The overall mortality rate was 35.8%. Non-survivors had higher rates of composite morbidity, acute kidney failure, and cardiac arrest (all p < 0.001). Survivors had longer hospital and ICU LOS, and more ventilator days (all p < 0.001), as well as higher rates of deep venous thrombosis (p = 0.009) and pulmonary embolism (p = 0.037). Independent predictors of mortality included age categories 75-84 years (Odds Ratio [OR]: 2.00; 95% Confidence Interval [CI]: 1.31-3.04) and 85-94 years (OR: 6.29; 95% CI: 3.04-13.01), Glasgow Coma Scale (GCS) < 9 (OR: 4.84; 95% CI: 2.96-7.93), Abbreviated Injury Scale (AIS) > 2 for head injuries (OR: 2.16; 95% CI: 1.36-3.42) and abdominal injuries (OR: 1.77; 95% CI: 1.13-2.77), pancreatic injury AIS grade 5 (OR: 12.38; 95% CI: 2.80-54.83), and concomitant vena cava (OR: 20.40; 95% CI: 2.07-200.73) and lung injuries (OR: 1.76; 95% CI: 1.13-2.75).
Conclusion:In-hospital mortality for blunt pancreatic injury in older adults is 35.8%. This study identified key independent predictors of mortality, including advanced age, GCS < 9, AIS > 2 for head and abdominal injuries, AIS grade 5 for pancreatic injury, and concomitant vena cava and lung injuries. Early identification of risk factors for prolonged hospitalization and mortality is essential for guiding and escalating care, improving communication with patients and their families, and effectively planning discharge disposition.