“Management of Duodenal Trauma: A Retrospective Review From The Pan-American Trauma Society"

Introduction The operative management of duodenal trauma remains controversial. Our hypothesis is that a simplified operative approach could lead to better outcomes. Methods We conducted an international multicenter study, involving thirteen centers. We performed a retrospective review from January 2007 to December of 2016. Data on demographics, mechanism of trauma, blood loss, operative time, and associated injured organs were collected. Outcomes included post-operative intra-abdominal sepsis, leak, need for unplanned surgery, length of stay, renal failure and mortality. We used the research Electronic Data Capture (REDCap) tool to store the data. Poisson regression using a backward selection method was used to identify independent predictors of mortality. Results We collected data in 372 patients with duodenal injuries. Although the duodenal trauma was complex (Median ISS: 18 Interquartile range (2 – 3), AIS: 3.5 (3 – 4), AAST grade: 3 (2 - 3)), primary repair alone was the most common type of operative management (80%, n=299). Overall mortality was 24%. On univariate analysis, mortality was associated with male gender, lower admission systolic blood pressure, need for transfusion before operative repair, higher intraoperative blood loss, longer operative time, renal failure requiring renal replacement therapy, higher ISS, and associated pancreatic injury. Poisson regression showed, higher ISS, associated pancreatic injury, post-operative renal failure requiring renal replacement therapy, the need for preoperative transfusion, and male gender remained significant predictors of mortality. Duodenal suture line leak was statistically significantly lower and patients who had primary repair over every AAST grade of injury. Conclusions The need for transfusion prior to the OR, associated pancreatic injuries and postoperative renal failure are predictors of mortality for patients with duodenal injuries. Primary repair alone is a common and safe operative repair even for complex injuries when feasible. Abstract Level of evidence Level IV retrospective Conflicts of interest None Presented as an oral presentation at the 77th American Association for the Surgery of Trauma (AAST) annual meeting in San Diego, September of 2018. Corresponding Author: Paula Ferrada MD FACS, VCU Surgery Trauma, Critical Care and Emergency Surgery. Email: pferrada@mcvh-vcu.edu. Mailing Address: PO Box 980454. Richmond, VA 23298-0454, Location/Delivery Address: West Hospital, 15th Floor, East Wing, 1200 E. Broad St., Richmond, VA 23298 The authors do not have any conflicts of interest related to this work. © 2018 Lippincott Williams & Wilkins, Inc.

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