Emre Sivrikoz1, Pedro G Teixeira1, Shelby Resnick1, Kenji Inaba1, Peep Talving1, Demetrios Demetriades2. 1. Division of Acute Care Surgery, Department of Surgery, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA. 2. 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.
Abstract
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.
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.
Authors: Shenise Gilyard; Kaitlin Shinn; Nariman Nezami; Laura K Findeiss; Sean Dariushnia; April A Grant; C Matthew Hawkins; Gail L Peters; Bill S Majdalany; Janice Newsome; Zachary L Bercu; Nima Kokabi Journal: Semin Intervent Radiol Date: 2020-03-04 Impact factor: 1.513