Risk factors for the leakage of the repair of duodenal wounds. A secondary analysis of the Panamerican Trauma Society multicenter retrospective review.

Abstract

Abstract Background: Leak of the repair of a traumatic duodenal perforation (TDP) determines intra-abdominal infection, fistula, and mortality. The risk factors for the leak of a TDP have yet to be entirely studied. We performed a secondary analysis of a retrospectively collected database conformed from eleven trauma centers from the Americas to identify risk factors for filtration of a TDP. Methods: Patients ≥18 years old with duodenal trauma, surgically treated from 2006 to 2017, were included. Subjects who died during the first 48 hours were excluded. Demographics, trauma mechanism, trauma severity, associated injuries, transfusions, and type of surgical treatment were examined as potential risk factors for a leak of the surgical repair of the TDP. Multiple logistic regression (MLR) modeling was used to identify independent contributors to the risk of leak. Results: We included 288 patients. Median age was 29 years (IQR 22-43), and 236(81.9%) subjects were males. Penetrating trauma occurred in 223 (77.3%) patients. Duodenal injury AAST severity was grade 3 in 180 (62.5%) cases and grade 4-5 in 40 (13.9%) patients. Duodenal leakage developed in 50 (17.4%) subjects. Compared with the subjects without a leak, the patients who leaked had significantly lower SBP at admission, higher ISS, higher abdominal AIS, and a higher proportion of duodenal AAST 3 lesions. MLR identified as independent predictors of leakage of the duodenal repair hypotension on admission, abdominal AIS, duodenal AAST grade 3, and duodenal repair with techniques different from primary repair. The discriminative ability (AUC= 0.824 (0.766-0.883) and goodness to fit of the model (p = 0.271) were good. Conclusion: Hypotension at arrival, abdominal AIS, duodenal OIS=3, and complex surgical procedures were identified as independent risk factors for duodenal repair leakage. We recommend abandoning complex surgical procedures, including duodenal tube decompression, favoring primary duodenal repair.