Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Abstract

AIMTo benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries.METHODSA prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni- and multivariate logistic regression analysis was applied.RESULTSOverall 238 complications occurred in 95 (73%) patients of which 73% were ASGS grades 3-6. Nineteen patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score (RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy (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.CONCLUSIONThis ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.

Does drainage or resection predict subsequent interventions and long-term quality of life in patients with Grade IV pancreatic injuries: A population-based analysis

“…[2][3][4][5][6][7] It must also be mentioned that these procedures (particularly pancreatic head resections) are best completed by experienced surgeons in the context of patient stability. 5,8 If hemodynamic instability and/or physiologic exhaustion persists, then simple drainage of any pancreatic injury (and associated vascular hemorrhage control), with a plan to return to the operating room for a secondary resection/reconstruction as necessary, is the preferred procedure of choice. [9][10][11][12] Unlike the traditional pathways described above, Grade IV pancreatic injuries represent a more intriguing cohort given the possibility of initial drainage versus resection/reconstruction options.…”

“…[9][10][11][12] Unlike the traditional pathways described above, Grade IV pancreatic injuries represent a more intriguing cohort given the possibility of initial drainage versus resection/reconstruction options. [2][3][4][5][6][7][9][10][11][12][13][14][15][16][17][18][19] Not only does this particular grade include a wide variety of morphologic injuries (e.g., ampullary vs. pancreatic head), 1 the limited experience of trauma surgeons with both Grade IV injury volumes, as well as complex pancreatic head resections (i.e., pancreatoduodenectomy, extended distal pancreatectomy with duct closure, duodenal-preserving pancreatic head resection, central pancreatectomy with reconstruction), makes the surgical management of this scenario strongly debated with both opinion and passion. The alternative, nonresectional treatment is described by simple drainage of the pancreatic head.…”

Outcomes of Laparoscopic Versus Open Liver Resection: A Case-control Study With Propensity Score Matching

“…Complications were graded according to the Accordion Classification system. 13,14 The primary endpoint of the study was postoperative morbidity. The secondary endpoint was postoperative mortality, defined as death within 30 days of liver resection.…”

“…Postoperative analgesic requirements were obtained from postoperative orders. Complications were graded according to the Accordion Classification system 13,14 …”

Applying refined pancreaticogastrostomy techniques in pancreatic trauma

“…We, too, have grappled with the complexities of establishing a safe method for a pancreatic anastomosis in pancreatic trauma[ 2 ]. Our clinical experience is based on one of the largest active databases of complex pancreatic injuries in the world.…”