The Effect of Angioembolization Versus Open Exploration for Moderate to Severe Blunt Liver Injuries on Mortality.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
accepted:
11
01
2023
medline:
5
4
2023
pubmed:
28
1
2023
entrez:
27
1
2023
Statut:
ppublish
Résumé
Blunt liver injury is common and is associated with a high morbidity and mortality. More severe injuries often require either angioembolization or open operative repair, depending on patient factors and facility capacity. We sought to describe patient outcomes based on intervention type. We analyzed the National Trauma Data Bank (2017-2019) using ICD-10 codes to identify adult patients with blunt liver injury and their interventions. AIS (Abbreviated Injury Scale) scores were used to group patients based on liver injury severity (AIS 2-6). Logistic regression modeling was used to estimate the adjusted odds ratio of death based on intervention type, excluding patients with severe injury. Of 2,848,592 trauma patients, 50,250 patients had a blunt liver injury. Among patients with AIS 3/4/5 injury, 1,140 had angioembolization, 1,529 had an open repair, and 188 had both angioembolization and open repair. In comparison with no intervention and adjusted for age, sex, shock index, ISS, and transfusion total (first four hours), angioembolization was associated with a significant decrease in the odds of mortality for patients with an AIS 4 (OR 0.68, 95% CI 0.47, 0.99) and AIS 5 injury (OR 0.39, 95% CI 0.24, 0.64). In patients with an AIS 5 injury, open repair had an increased odds of mortality at OR 1.99 (95% CI 1.47, 2.69). In an analysis of a national trauma database, patients with a moderate to severe injury (AIS 4 or 5), angioembolization was associated with a significant reduction in the adjusted odds of mortality compared to open repair and should be considered when clinically appropriate.
Identifiants
pubmed: 36705742
doi: 10.1007/s00268-023-06926-5
pii: 10.1007/s00268-023-06926-5
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1271-1281Informations de copyright
© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.
Références
Tinkoff G, Esposito TJ, Reed J et al (2008) American association for the surgery of trauma organ injury scale I: spleen, liver, and kidney, validation based on the National Trauma Data Bank. J Am Coll Surg 207:646–655
doi: 10.1016/j.jamcollsurg.2008.06.342
pubmed: 18954775
Scollay JM, Beard D, Smith R et al (2005) Eleven years of liver trauma: the Scottish experience. World J Surg 29:744–749
doi: 10.1007/s00268-005-7752-x
pubmed: 15880277
David Richardson J, Franklin GA, Lukan JK et al (2000) Evolution in the management of hepatic trauma: a 25-year perspective. Ann Surg 232:324–330
doi: 10.1097/00000658-200009000-00004
pubmed: 10973382
pmcid: 1421146
Parks R, Chrysos E, Diamond T (1999) Management of liver trauma. Br J Surg 86:1121–1135
doi: 10.1046/j.1365-2168.1999.01210.x
pubmed: 10504364
Matthes G, Stengel D, Seifert J et al (2003) Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole-body helical computed tomography. World J Surg 27:1124–1130
doi: 10.1007/s00268-003-6981-0
pubmed: 12917767
Matthes G, Stengel D, Bauwens K et al (2006) Predictive factors of liver injury in blunt multiple trauma. Langenbecks Arch Surg 391:350–354
doi: 10.1007/s00423-005-0001-9
pubmed: 16261391
Chien L-C, Lo S-S, Yeh S-Y (2013) Incidence of liver trauma and relative risk factors for mortality: a population-based study. J Chin Med Assoc 76:576–582
doi: 10.1016/j.jcma.2013.06.004
pubmed: 23890836
Chmatal P, Kupka P, Fuksa Z et al (2008) Liver trauma usually means management of multiple injuries: analysis of 78 patients. Int Surg 93:72–77
pubmed: 18998284
Malhotra AK, Fabian TC, Croce MA et al (2000) Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 231:804–813
doi: 10.1097/00000658-200006000-00004
pubmed: 10816623
pmcid: 1421069
Croce MA, Fabian TC, Menke PG et al (1995) Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trial. Ann Surg 221:744–753 (discussion 753–745)
doi: 10.1097/00000658-199506000-00013
pubmed: 7794078
pmcid: 1234706
Pachter HL, Knudson MM, Esrig B et al (1996) Status of nonoperative management of blunt hepatic injuries in 1995: a multicenter experience with 404 patients. J Trauma 40:31–38
doi: 10.1097/00005373-199601000-00007
pubmed: 8576995
Goan YG, Huang MS, Lin JM (1998) Nonoperative management for extensive hepatic and splenic injuries with significant hemoperitoneum in adults. J Trauma 45:360–364 (discussion 365)
doi: 10.1097/00005373-199808000-00026
pubmed: 9715196
Cadili A, Gates J (2021) The role of angioembolization in hepatic trauma. Am Surg 87:1793–1801
doi: 10.1177/0003134820973729
pubmed: 33342269
Green CS, Bulger EM, Kwan SW (2016) Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg 80:529–537
doi: 10.1097/TA.0000000000000942
pubmed: 26670113
pmcid: 4767638
Charlson M, Szatrowski TP, Peterson J et al (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251
doi: 10.1016/0895-4356(94)90129-5
pubmed: 7722560
Samuel AM, Grant RA, Bohl DD et al (2015) Delayed surgery after acute traumatic central cord syndrome is associated with reduced mortality. Spine (Phila Pa 1976) 40:349–356
doi: 10.1097/BRS.0000000000000756
pubmed: 25757037
Carrillo EH, Platz A, Miller FB et al (1998) Non-operative management of blunt hepatic trauma. Br J Surg 85:461–468
doi: 10.1046/j.1365-2168.1998.00721.x
pubmed: 9607525
Suen K, Skandarajah AR, Knowles B et al (2016) Changes in the management of liver trauma leading to reduced mortality: 15-year experience in a major trauma centre. ANZ J Surg 86:894–899
doi: 10.1111/ans.13248
pubmed: 26235220
Saltzherr TP, van der Vlies CH, van Lienden KP et al (2011) Improved outcomes in the non-operative management of liver injuries. HPB 13:350–355
doi: 10.1111/j.1477-2574.2011.00293.x
pubmed: 21492335
pmcid: 3093647
Gaarder C, Naess PA, Eken T et al (2007) Liver injuries–improved results with a formal protocol including angiography. Injury 38:1075–1083
doi: 10.1016/j.injury.2007.02.001
pubmed: 17706220
Asensio JA, Roldán G, Petrone P et al (2003) Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps. J Trauma Acute Care Surg 54:647–654
doi: 10.1097/01.TA.0000054647.59217.BB
Stassen NA, Bhullar I, Cheng JD et al (2012) Nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73:S288–S293
doi: 10.1097/TA.0b013e318270160d
pubmed: 23114483
Ahmed N, Kassavin D, Kuo Y-H et al (2013) Sensitivity and specificity of CT scan and angiogram for ongoing internal bleeding following torso trauma. Emerg Med J 30:e14–e14
doi: 10.1136/emermed-2011-200376
pubmed: 22505301
Cadili A, Gates J (2021) The role of angioembolization in hepatic trauma. Am Surg 87(11):1793–1801
doi: 10.1177/0003134820973729
pubmed: 33342269
Matsumoto S, Cantrell E, Jung K et al (2018) Influence of postoperative hepatic angiography on mortality after laparotomy in Grade IV/V hepatic injuries. J Trauma Acute Care Surg 85:290–297
doi: 10.1097/TA.0000000000001906
pubmed: 29613955
Matsushima K, Hogen R, Piccinini A et al (2020) Adjunctive use of hepatic angioembolization following hemorrhage control laparotomy. J Trauma Acute Care Surg 88:636–643
doi: 10.1097/TA.0000000000002591
pubmed: 31977997
Kutcher ME, Weis JJ, Siada SS et al (2015) The role of computed tomographic scan in ongoing triage of operative hepatic trauma: a western trauma association multicenter retrospective study. J Trauma Acute Care Surg 79:951–956
doi: 10.1097/TA.0000000000000692
pubmed: 26335774
van der Wilden GM, Velmahos GC, Emhoff T et al (2012) Successful nonoperative management of the most severe blunt liver injuries: a multicenter study of the research consortium of New England centers for trauma. Arch Surg 147:423–428
pubmed: 22785635
Duane TM, Como JJ, Bochicchio GV et al (2004) Reevaluating the management and outcomes of severe blunt liver injury. J Trauma Acute Care Surg 57:494–500
doi: 10.1097/01.TA.0000141026.20937.81
Misselbeck TS, Teicher EJ, Cipolle MD et al (2009) Hepatic angioembolization in trauma patients: indications and complications. J Trauma 67:769–773
pubmed: 19820584
Mohr AM, Lavery RF, Barone A et al (2003) Angiographic embolization for liver injuries: low mortality, high morbidity. J Trauma 55:1077–1081 (discussion 1081-1072)
doi: 10.1097/01.TA.0000100219.02085.AB
pubmed: 14676654
Dabbs DN, Stein DM, Scalea TM (2009) Major hepatic necrosis: a common complication after angioembolization for treatment of high-grade liver injuries. J Trauma 66:621–627 (discussion 627-629)
pubmed: 19276729
Samuels JM, Urban S, Peltz E et al (2020) A modern, multicenter evaluation of hepatic angioembolization–complications and readmissions persist. Am J Surg 219:117–122
doi: 10.1016/j.amjsurg.2019.06.021
pubmed: 31272677
Samuels JM, Carmichael H, Kovar A et al (2020) Reevaluation of hepatic angioembolization for trauma in stable patients: weighing the risk. J Am Coll Surg 231(123–131):e123
doi: 10.1016/j.jamcollsurg.2020.05.006
Tignanelli CJ, Joseph B, Jakubus JL et al (2018) Variability in management of blunt liver trauma and contribution of level of American College of Surgeons Committee on Trauma verification status on mortality. J Trauma Acute Care Surg 84:273–279
doi: 10.1097/TA.0000000000001743
pubmed: 29194321