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Citation
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Sivrikoz E, Teixeira PG, Resnick S, Inaba K, Talving P, Demetriades D. Am. J. Surg. 2015; 209(4): 742-746. |
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Affiliation
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Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA. Electronic address: demetria@usc.edu. |
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Abstract
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BACKGROUND: The role of angiointervention (ANGIO) in the management of high-grade liver injuries is not clear and there are concerns about increased complications.
METHODS: National Trauma Data Bank study, isolated grade IV and V blunt liver injuries. Patients with major associated intra-abdominal or extra-abdominal injuries were excluded. Logistic regression analysis was performed to identify independent predictors of mortality and complications.
RESULTS: Six thousand four hundred two patients met the criteria for inclusion. Laparotomy was performed in 32% of the patients and nonoperative management in 68%. Overall, 11% of the patients underwent ANGIO. Patients in the ANGIO group were significantly more likely to be older than 55 years than non-ANGIO patients and more likely to have Injury Severity Scores greater than 25. After stepwise logistic regression, ANGIO was an independent predictor of survival (P <.001). In the group of patients managed operatively, it was independently associated with a lower mortality (P <.001). Similarly, in the nonoperative group, it was independently associated with a lower mortality (5.4% vs 9.5%, P =.008). ANGIO was associated with increased systemic complications.
CONCLUSIONS: ANGIO in blunt, severe liver injuries is associated with reduced mortality and increased complications, in both operative and nonoperative management.
Language: en |