Outcomes of Operative versus Minimally Invasive Management in Hemodynamically Stable Adult Patients With Moderate to Severe Pancreatic Trauma per Mechanism and Grade of Injury: A National Analysis

Pancreatic trauma remains a major source of morbidity and mortality, with rates as high as 53% and 21.2%, respectively. This study aims to compare clinical outcomes in hemodynamically stable adult pancreatic trauma patients managed with minimally invasive versus operative management.

This retrospective study utilized the American College of Surgeons Trauma Quality Improvement Program Public Use File dataset (2017 to 2023) to evaluate outcomes in hemodynamically stable adult (≥18 y) trauma patients with moderate-to-severe (Abbreviated Injury Scale abdomen ≥2, Injury Severity Score ≥9) pancreatic trauma who underwent operative or minimally invasive management. Patients were stratified by injury grade and injury mechanism. Primary outcomes included in-hospital mortality. Secondary outcomes included complications such as deep vein thrombosis and pulmonary embolism.

In hemodynamically stable adult trauma patients with either high-grade (American Association for the Surgery of Trauma≥3) or low-grade (≤2) moderate-to-severe pancreatic injuries, minimally invasive management was not significantly associated with in-hospital mortality (adjusted odds ratio: 0.8, 95% confidence interval: 0.3-1.9, P = 0.5, standard error: 0.5). Similarly, in patients with either blunt or penetrating injuries, no significant association with in-hospital mortality (adjusted odds ratio: 0.6, 95% confidence interval: 0.1-2.3, P = 0.4, standard error: 0.7) was found in those treated with minimally invasive management.

Minimally invasive management may be considered a feasible option in hemodynamically stable adult trauma patients with moderate to severe pancreatic injuries, as it was associated with comparable clinical outcomes compared to operative management.