Skip to main content

Advertisement

SpringerLink
Log in

Early mobilization of patients with non-operative liver and spleen injuries is safe and cost effective

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

There is no standard protocol for the management of non-operative liver or spleen injuries (LSI). In 2011, our institution changed the non-operative management (NOM) protocol of LSI from prolonged bed rest (PBR) to early mobilization (EM). We aim to show that EM safely decreases length of stay (LOS), ICU LOS, and cost.

Methods

We conducted a retrospective review in which non-operative LSI patients observed PBR from January 2008 through July 2011 and were mobilized early from August 2011 through December 2014. Endpoints assessed were length of bed rest, hospital LOS, ICU LOS, failure of NOM, cost, angiography/embolization, and mortality.

Results

There were a total of 184 patients with LSI who met study criteria and were not excluded. 77 patients utilized PBR between 2008 and 2011 and 107 followed EM protocol between 2011 and 2014. There was no significant difference in the male to female ratio, age, ISS, anticoagulant use, or MOI. Both groups had similar injury profiles. PBR included 34 liver injuries, 45 splenic injuries and two patients with both. EM included 63 liver injuries, 55 splenic injuries and 11 patients with both (for liver injury p = 0.053, for splenic injury p = 0.37, and for combined p = 0.08). LOS and cost were significantly decreased in the EM cohort. LOS was shortened by 1.07 days (p = 0.005) and cost of hospitalization was reduced by $7077 (p = 0.046). There was no difference in NOM failure, angiography/embolization, or mortality.

Conclusion

EM in non-operative LSI is safe and cost-effective. It results in decreased LOS and cost without increasing failure of NOM, angiography, embolization, or mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS) (online). (2005).

  2. Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths. Final data for 2007. National vital statistics reports. Hyattsville: National Center for Health Statistics. http://www.cdc.gov/injury/wisqars2. 2010;58(19). Accessed Aug 2016

  3. Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS). National hospital discharge survey: 2007 summary. National health statistics reports, no. 29. Atlanta: NCHS; 2010.

    Google Scholar 

  4. London J, Parry L. Galante J. Battistella F. Safety of early mobilization of patients with blunt solid organ injuries. Arch Surg. 2008;143(10):972–6.

    Article  Google Scholar 

  5. Ahmed N, Vernick JJ. Management of liver trauma in adults. J Emer Trauma Shock. 2011;4(1):114–9.

    Article  Google Scholar 

  6. McCray V, Davis J, Lemaster D, Parks S. Observation for nonoperative management of the spleen: how long is long enough? J Trauma. 2008;65:1354–8.

    Article  Google Scholar 

  7. Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ Jr, Sangosanya A, Schuster K, Seamon M, Tchorz KM, Zarzuar BL, Kerwin A. Eastern Association for the Surgery of Trauma. Selective nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guidelines. J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S288–293.

    Google Scholar 

  8. Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ Jr, Sangosanya A, Schuster K, Seamon M, Tchorz KM, Zarzuar BL, Kerwin A. Eastern Association for the Surgery of Trauma. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guidelines. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S294–300.

    PubMed  Google Scholar 

  9. Parks N, Davis J, Forman D, Lemaster D. Observation for nonoperative management of blunt liver injuries: how long is long enough? J Trauma. 2011;70:626–9.

    Article  Google Scholar 

  10. Kozar RA, Moore FA, Moore EE, West M, Cocanaur CS, Davis J, Biffl WL, McIntyre RC Jr. Western trauma critical decisions in trauma: nonoperative management of adult blunt hepatic trauma. J Trauma. 2009;67:1144–9.

    Article  Google Scholar 

  11. Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, Pritchard FE. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg. 2000;231:804–13.

    Article  CAS  Google Scholar 

  12. Meredith JW, Young JS, Bowling J, Roboussin D. Nonoperative management of blunt hepatic trauma: the exception or the rule? J Trauma. 1994;36:529–35.

    Article  CAS  Google Scholar 

  13. Velmahos GC, Toutouzas KG, Radin R, Chan L, Demetriades D. Nonoperative treatment of blunt injury to solid abdominal organs. A prospective study. Arch Surg. 2003;138:844–51.

    Article  Google Scholar 

  14. Stein D, Scalea T. Nonoperative management of spleen and liver injuries. J Intensive Care Med. 2006;21:296.

    Article  Google Scholar 

  15. Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg. 1998;227:708–19.

    Article  CAS  Google Scholar 

  16. Haan JM, Bocchicchio GV, Kramer N, Scalea TM. Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma. 2005;58:492–8.

    Article  Google Scholar 

  17. Haan JM, Biffl W, Knudson MM, Davis KA, Oka T, Majercik S, Dicker R, Marder S, Scalea TM. Western Trauma Association Multi- Institutional Trials Committee. Splenic embolization revisited: a multicenter review. J Trauma. 2004;56:542–7.

    Article  Google Scholar 

  18. Sharma OP, Oswanksi MF, Singer D, Raj SS, Daoud YAH. Assessment of nonoperative management of blunt spleen and liver trauma. Am Surg. 2005;71:379–86.

    PubMed  Google Scholar 

  19. Sclafani SJ, Shaftan GW, Scalea TM, Patterson LA, Kohl L, Kantor A, Herkowitz MM, Hoffer EK, Henry S, Dresner LS. Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma. 1995;39:818–27.

    Article  CAS  Google Scholar 

  20. Goan Y, Huang M, Lin M. Nonoperative management for extensive hepatic and splenic injuries with significant hemoperitoneum in adults. J Trauma. 1998;45:360–5.

    Article  CAS  Google Scholar 

  21. Smith J, Armen S, Cook C, Martin L. Blunt splenic injuries: have we watched long enough?. J Trauma. 2008; 656–65.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hahnemann University Hospital, Drexel University College of Medicine, 215 N 15th St MS 413, Philadelphia, PA, 19102, USA

    Amanda Teichman, Dane Scantling & Brendan McCracken

  2. Atlanticare Regional Medical Center, 1925 Pacific Avenue, Atlantic, NJ, 08401, USA

    James Eakins

Authors
  1. Amanda Teichman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dane Scantling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brendan McCracken
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Eakins
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Dr. Teichman was involved in idea conception, data collection and analysis, manuscript creation and submission. Dr. Scantling was involved in data analysis, manuscript creation and submission. Dr. McCracken and Dr. Eakins were involved in project conception and manuscript drafting.

Corresponding author

Correspondence to Amanda Teichman.

Ethics declarations

Conflict of interest

Amanda Teichman, Dane Scantling, Brendan McCracken and James Eakins declare that they have no conflict of interest.

Ethical standards

Amanda Teichman, Dane Scantling, Brendan McCracken, and James Eakins report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

Research involving human participants/animals

Research involved human subjects and was of a retrospective nature.

Informed consent

Informed consent was unnecessary for this study as it was a retrospective review and all material was de-identified.

Additional information

Amanda Teichman and Dane Scantling contributed in the capacity of first author.

This study was presented at the 75th annual meeting of the American Association for the Surgery of Trauma, 14–17 September 2016, in Waikoloa, Hawaii.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Teichman, A., Scantling, D., McCracken, B. et al. Early mobilization of patients with non-operative liver and spleen injuries is safe and cost effective. Eur J Trauma Emerg Surg 44, 883–887 (2018). https://doi.org/10.1007/s00068-017-0864-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-017-0864-9

Keywords

Search

Navigation