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Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

A paradigm shift toward non-operative management (NOM) of blunt hepatic trauma has occurred. With advances in percutaneous interventions, even severe liver injuries are being managed non-operatively. However, although overall mortality is decreased with NOM, liver-related morbidity remains high. This study was undertaken to explore the morbidity and mortality of blunt hepatic trauma in the era of angioembolization (AE).

Methods

A retrospective cohort of trauma patients with blunt hepatic injury who were assessed at our centre between 1999 and 2011 were identified. Logistic regression was undertaken to identify factors increasing the likelihood of operative management (OM) and mortality.

Results

We identified 396 patients with a mean ISS of 33 (±14). Sixty-two (18 %) patients had severe liver injuries (≥AAST grade IV). OM occurred in 109 (27 %) patients. Logistic regression revealed high ISS (OR 1.07; 95 % CI 1.05−1.10), and lower systolic blood pressure on arrival (OR 0.98; 95 % CI 0.97−0.99) to be associated with OM. The overall mortality was 17 %. Older patients (OR 1.05; 95 % CI 1.03−1.07), those with high ISS (OR 1.11; 95 % CI 1.08−1.14) and those requiring OM (OR 2.89; 95 % CI 1.47−5.69) were more likely to die. Liver-related morbidities occurred in equal frequency in the OM (23 %) and AE (29 %) groups (p = 0.32). Only 3 % of those with NOM experienced morbidity.

Conclusions

The majority of patients with blunt hepatic trauma can be successfully managed non-operatively. Morbidity associated with NOM was low. Patients requiring AE had morbidity similar to OM.

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Conflict of interest

Kimberly Bertens, Kelly Vogt and Daryl Gray declare that they have no conflict of interest. Roberto Hernandez-Alejandro has received speaker honorariums from Roche, Sarnoff, Johnson & Johnson, ConMed, Astellas, Novartis and Merck. Roberto Hernandez-Alejandro has also received research grants from Roche and Novartis, although none of these funds were applied to this manuscript.

Ethical Standards

This project received research approval from the Research Ethics Board at Western University and was therefore performed in accordance with the ethical standards set forth in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    K. A. Bertens, K. N. Vogt, R. Hernandez-Alejandro & D. K. Gray

  2. Multi-Organ Transplant Program, London Health Sciences Centre, London, ON, Canada

    R. Hernandez-Alejandro

  3. Trauma Program, London Health Sciences Centre, London, ON, Canada

    K. N. Vogt & D. K. Gray

  4. Division of General Surgery, London Health Sciences Centre, Room E2-217, Victoria Hospital, 800 Commissioners Road East, London, ON, N6A 5W9, Canada

    K. A. Bertens

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  1. K. A. Bertens
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  2. K. N. Vogt
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  3. R. Hernandez-Alejandro
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  4. D. K. Gray
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Correspondence to K. A. Bertens.

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Bertens, K.A., Vogt, K.N., Hernandez-Alejandro, R. et al. Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?. Eur J Trauma Emerg Surg 41, 81–86 (2015). https://doi.org/10.1007/s00068-014-0431-6

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  • DOI: https://doi.org/10.1007/s00068-014-0431-6

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