Surgical versus Non-Surgical Management of High-Grade Pediatric Pancreatic Trauma: A National TQIP Analysis Stratified by Hemodynamic Stability

While non-surgical management is the mainstay of low-grade pancreatic trauma treatment, the optimal management of high-grade pancreatic trauma remains unclear. This study evaluates surgical versus non-surgical management and associated clinical outcomes in high-grade pancreatic trauma patients. This retrospective cohort study, utilizing the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) database from 2017 to 2023, selected pediatric patients (<18 years) with high-grade pancreatic injuries (grade III–V) who underwent surgical versus non-surgical management, then stratified outcomes by hemodynamic status on arrival. Primary outcomes included 24-hour and in-hospital mortality. Secondary outcomes included non-operative management (NOM) failure rate, transfusion volume, complication rates, intensive care unit length of stay (ICU-LOS), and ventilator-free days (VFDs). A total of 223 patients were included. In-hospital mortality occurred only in the surgical group (6.7% vs. 0%; p = 0.041); however, mortality events were infrequent and interpreted cautiously. The overall non-surgical management failure rate was 8.7%. Adjusted analyses demonstrated no statistically significant differences in total transfusion volume (β = 2.313, 95% CI: −15.351–19.976, p = 0.795, standard error [SE] = 8.894), ICU-LOS (β = − 1.871, 95% CI: −7.507–3.765, p = 0.510, SE = 2.829), or VFDs (β = − 4.315, 95% CI: −10.872–2.242, p = 0.191, SE = 3.249) between groups. Findings were consistent across hemodynamically stable and unstable subgroups. Non-surgical management may be a reasonable initial strategy in carefully selected pediatric patients with high-grade pancreatic trauma, with a low observed failure rate and comparable short-term resource utilization outcomes. However, findings should be interpreted cautiously within the constraints of a retrospective database study.