Does When We Operate Matter? Revisiting Surgical Timing in Pancreatic Trauma

Pancreatic injuries are rare but are associated with high morbidity and mortality, particularly when diagnosis or treatment is delayed. However, the optimal timing for surgical intervention remains unclear. This study aimed to assess the impact of surgical timing on outcomes of hemodynamically stable patients with blunt pancreatic trauma using data from the Trauma Quality Improvement Program (TQIP).

This retrospective study analyzed TQIP data (2017-2019) for hemodynamically stable patients with blunt pancreatic injuries who underwent pancreatic surgery. Outcomes including mortality, complications, hospital length of stay (LOS), intensive care unit (ICU) LOS, and ventilator days were evaluated based on the time (in hours) from emergency department (ED) arrival to surgery. Patients were categorized into two groups based on surgical timing: within 48 h or beyond 48 h of ED arrival. Multivariate logistic regression was performed to identify independent predictors of complications.

Among the 703 patients included in the study, a longer interval from ED arrival to surgery was linearly associated with increased hospital LOS, ICU LOS, and duration of mechanical ventilation. Multivariable analysis revealed that delayed surgery (> 48 h) was an independent predictor of complications (Odds Ratio = 3.831; p = 0.002). Interestingly, mortality rates did not differ significantly between the early and delayed intervention groups. Furthermore, a subgroup analysis of patients treated within the initial 48-h window showed that the precise timing of surgery within this period did not significantly impact complication rates (p = 0.256).

Pancreatic surgery delayed beyond 48 h significantly increases the risk of complications and prolongs hospitalization. When performed within this time frame, additional delay appears to have minimal impact, allowing time for thorough evaluation and surgical planning.