Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?

Humans Spleen / injuries Abdominal Injuries / complications Wounds, Nonpenetrating / complications Anticoagulants / therapeutic use Propensity Score Retrospective Studies Injury Severity Score
Adults Blunt abdominal injury Preinjury anticoagulation Solid organ injury Trauma

Journal

American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473

Informations de publication

Date de publication:
11 2022
Historique:
received: 25 03 2022
revised: 06 06 2022
accepted: 23 06 2022
pubmed: 2 7 2022
medline: 15 11 2022
entrez: 1 7 2022
Statut: ppublish

Résumé

This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM. A 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed. A matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10-24]vs.17[12-26]days,p = 0.04) and ICU LOS (11[6-17]vs.11[7-18]days,p = 0.01). Among nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants. Level III. Therapeutic/care management.

Sections du résumé

BACKGROUND
This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM.
METHODS
A 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed.
RESULTS
A matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10-24]vs.17[12-26]days,p = 0.04) and ICU LOS (11[6-17]vs.11[7-18]days,p = 0.01).
CONCLUSION
Among nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants.
LEVEL OF EVIDENCE
Level III.
STUDY TYPE
Therapeutic/care management.

Identifiants

DOI: 10.1016/j.amjsurg.2022.06.019 PMID: 35778232
pubmed: 35778232
pii: S0002-9610(22)00439-1
doi: 10.1016/j.amjsurg.2022.06.019
pii:
doi:

Substances chimiques

Anticoagulants 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1308-1313

Informations de copyright

Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of competing interest There are no identifiable conflicts of interest to report.

Auteurs

Raul Reina (R)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: rreinalimon@arizona.edu.

Tanya Anand (T)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: tanyaanand@surgery.arizona.edu.

Sai K Bhogadi (SK)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: saikbhogadi@arizona.edu.

Adam Nelson (A)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: adamcnelson@arizona.edu.

Hamidreza Hosseinpour (H)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: hosseinpourh@arizona.edu.

Michael Ditillo (M)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: mfditillo@surgery.arizona.edu.

Khaled El-Qawaqzeh (K)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: khaledqawaqzeh@arizona.edu.

Lourdes Castanon (L)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: lourdescastanon@surgery.arizona.edu.

Collin Stewart (C)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: chstewart@surgery.arizona.edu.

Bellal Joseph (B)

Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: bjoseph@surgery.arizona.edu.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Nonoperative management of blunt abdominal...
questionsmedicales.fr › Systèmes sanguin et immunitaire › Système immunitaire › Système lymphatique › Tissu lymphoïde › Rate › Nonoperative management of blunt abdominal...
questionsmedicales.fr › Plaies et blessures › Traumatismes de l'abdomen › Nonoperative management of blunt abdominal...
questionsmedicales.fr › Plaies et blessures › Plaies non pénétrantes › Nonoperative management of blunt abdominal...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Agents hématologiques › Anticoagulants › Nonoperative management of blunt abdominal...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Score de propension › Nonoperative management of blunt abdominal...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Nonoperative management of blunt abdominal...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Score de gravité des lésions traumatiques › Nonoperative management of blunt abdominal...