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The Effect of Angioembolization Versus Open Exploration for Moderate to Severe Blunt Liver Injuries on Mortality

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Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

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Funding

Financial support was provided by the Department of Surgery at the University of North Carolina.

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Authors and Affiliations

  1. Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, 4006 Burnett Womack Building, Chapel Hill, NC, 27599-7228, USA

    Jared Gallaher, Victoria Burton, Andrew B. Schneider, Trista Reid, Lauren Raff, Charlotte B. Smith & Anthony Charles

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  1. Jared Gallaher
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  2. Victoria Burton
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  3. Andrew B. Schneider
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Correspondence to Jared Gallaher.

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Gallaher, J., Burton, V., Schneider, A.B. et al. The Effect of Angioembolization Versus Open Exploration for Moderate to Severe Blunt Liver Injuries on Mortality. World J Surg 47, 1271–1281 (2023). https://doi.org/10.1007/s00268-023-06926-5

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