Arnold, PeterBelchos, JessicaMeagher, AshleyRobbins, ChristopherSparks Joplin, TashaOrtiz, DamarisFerries, IanHartwell , Jennifer2024-06-132024-06-132022-12Arnold, P., Belchos, J., Meagher, A., Robbins, C., Sparks Joplin, T., Ortiz, D., Ferries, I., & Hartwell, J. (2022). Postoperative Pancreatic Fistula Following Traumatic Splenectomy: A Morbid and Costly Complication. Journal of Surgical Research, 280, 35–43. https://doi.org/10.1016/j.jss.2022.07.005https://hdl.handle.net/1805/41552Introduction: Development of clinically relevant postoperative pancreatic fistula (CR-POPF) in adult splenectomies following trauma occur in 1%-3% of cases. We hypothesized that the use of sutures in splenic hilum ligation compared to staples was associated with a reduced rate of CR-POPF incidence. Methods: Adult trauma patients (age ≥17 y) that underwent nonelective splenectomy from 2010 to 2020 were retrospectively evaluated from the trauma registries of all three adult level 1 trauma centers in Indiana. Patients were excluded if they were pregnant, currently incarcerated, expired within 72 h of admission, or had a pancreatic injury diagnosed preoperatively or intraoperatively. A Firth logistic regression using a penalized-maximum likelihood estimate for rare events was used for univariate predictive modeling (SPSS 28.0) of surgical technique on CR-POPF development. Results: Four hundred nineteen adult splenectomies following trauma were conducted; 278 were included. CR-POPF developed in 14 cases (5.0%). Sutures alone were used in 200 cases: seven developed CR-POPF (3.5%). Staples alone or in combination with sutures were used in 74 cases: seven developed CR-POPF (9.5%). There was no statistically significant difference between the use of sutures alone compared to the use of staples alone (P = 0.123) or in combination (P = 0.100) in CR-POPF incidence. Conclusions: Our 10-y retrospective review of CR-POPF finds the complication to be rare but morbid. This study was underpowered to show any difference in surgical technique. However, we do propose a new institutional norm that CR-POPF develop in 5% of splenectomies after trauma and conclude that further study of optimal technique for emergent splenectomy is warranted.en-USPublisher PolicyClinically relevant postoperative pancreatic fistula (CR-POPF)SplenectomyArticle