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Clinical characteristics and long-term outcomes following pancreatic injury – An international multicenter cohort study

Meijer, Laura L. ; Vaalavuo, Yrjö ; Regnér, Sara LU orcid ; Sallinen, Ville ; Lemma, Aurora ; Arnelo, Urban ; Valente, Roberto ; Westermark, Sofia ; An, David and Moir, John A.G. , et al. (2023) In Heliyon 9(6).
Abstract

Background: Trauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical characteristics and patient-reported long-term outcomes for pancreatic injury. Methods: A retrospective cohort study evaluating treatment for pancreatic injury in 11 centers across 5 European nations over >10 years was performed. Data relating to pancreatic injury and treatment were collected from hospital records. Patients reported quality of life (QoL), changes to employment and new or ongoing therapy due to index injury. Results: In all, 165 patients were included. The majority were male... (More)

Background: Trauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical characteristics and patient-reported long-term outcomes for pancreatic injury. Methods: A retrospective cohort study evaluating treatment for pancreatic injury in 11 centers across 5 European nations over >10 years was performed. Data relating to pancreatic injury and treatment were collected from hospital records. Patients reported quality of life (QoL), changes to employment and new or ongoing therapy due to index injury. Results: In all, 165 patients were included. The majority were male (70.9%), median age was 27 years (range: 6–93) and mechanism of injury predominantly blunt (87.9%). A quarter of cases were treated conservatively; higher injury severity score (ISS) and American Association for the Surgery of Trauma (AAST) pancreatic injury scores increased the likelihood for surgical, endoscopic and/or radiologic intervention. Isolated, blunt pancreatic injury was associated with younger age and pancreatic duct involvement; this cohort appeared to benefit from non-operative management. In the long term (median follow-up 93; range 8–214 months), exocrine and endocrine pancreatic insufficiency were reported by 9.3% of respondents. Long-term analgesic use also affected 9.3% of respondents, with many reported quality of life problems (QoL) potentially attributable to side-effects of opiate therapy. Overall, impaired QoL correlated with higher ISS scores, surgical therapy and opioid analgesia on discharge. Conclusions: Pancreatic trauma is rare but can lead to substantial short- and long-term morbidity. Near complete recovery of QoL indicators and pancreatic function can occur despite significant injury, especially in isolated, blunt pancreatic injury managed conservatively and when early weaning off opiate analgesia is achieved.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Clinical course, Interdisciplinary treatment, Long-term outcomes, Pancreatic trauma, Quality of life
in
Heliyon
volume
9
issue
6
article number
e17436
publisher
Elsevier
external identifiers
  • pmid:37408878
  • scopus:85162928158
ISSN
2405-8440
DOI
10.1016/j.heliyon.2023.e17436
language
English
LU publication?
yes
id
d12c8119-0c2f-4214-b90f-bf20552d0e47
date added to LUP
2023-09-18 11:42:33
date last changed
2024-04-19 01:14:27
@article{d12c8119-0c2f-4214-b90f-bf20552d0e47,
  abstract     = {{<p>Background: Trauma to the pancreas is rare but associated with significant morbidity. Currently available management guidelines are based on low-quality evidence and data on long-term outcomes is lacking. This study aimed to evaluate clinical characteristics and patient-reported long-term outcomes for pancreatic injury. Methods: A retrospective cohort study evaluating treatment for pancreatic injury in 11 centers across 5 European nations over &gt;10 years was performed. Data relating to pancreatic injury and treatment were collected from hospital records. Patients reported quality of life (QoL), changes to employment and new or ongoing therapy due to index injury. Results: In all, 165 patients were included. The majority were male (70.9%), median age was 27 years (range: 6–93) and mechanism of injury predominantly blunt (87.9%). A quarter of cases were treated conservatively; higher injury severity score (ISS) and American Association for the Surgery of Trauma (AAST) pancreatic injury scores increased the likelihood for surgical, endoscopic and/or radiologic intervention. Isolated, blunt pancreatic injury was associated with younger age and pancreatic duct involvement; this cohort appeared to benefit from non-operative management. In the long term (median follow-up 93; range 8–214 months), exocrine and endocrine pancreatic insufficiency were reported by 9.3% of respondents. Long-term analgesic use also affected 9.3% of respondents, with many reported quality of life problems (QoL) potentially attributable to side-effects of opiate therapy. Overall, impaired QoL correlated with higher ISS scores, surgical therapy and opioid analgesia on discharge. Conclusions: Pancreatic trauma is rare but can lead to substantial short- and long-term morbidity. Near complete recovery of QoL indicators and pancreatic function can occur despite significant injury, especially in isolated, blunt pancreatic injury managed conservatively and when early weaning off opiate analgesia is achieved.</p>}},
  author       = {{Meijer, Laura L. and Vaalavuo, Yrjö and Regnér, Sara and Sallinen, Ville and Lemma, Aurora and Arnelo, Urban and Valente, Roberto and Westermark, Sofia and An, David and Moir, John A.G. and Irwin, Ellen A. and Biesel, Esther A. and Hopt, Ulrich T. and Fichtner-Feigl, Stefan and Wittel, Uwe A. and Weniger, Maximilian and Karle, Henning and Bloemers, Frank W. and Sutton, Robert and Charnley, Richard M. and Ruess, Dietrich A. and Szatmary, Peter}},
  issn         = {{2405-8440}},
  keywords     = {{Clinical course; Interdisciplinary treatment; Long-term outcomes; Pancreatic trauma; Quality of life}},
  language     = {{eng}},
  number       = {{6}},
  publisher    = {{Elsevier}},
  series       = {{Heliyon}},
  title        = {{Clinical characteristics and long-term outcomes following pancreatic injury – An international multicenter cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.heliyon.2023.e17436}},
  doi          = {{10.1016/j.heliyon.2023.e17436}},
  volume       = {{9}},
  year         = {{2023}},
}