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Gross MG, Filiberto DM, Lehrman BH, Lenart EK, Easterday TS, Kerwin AJ, Byerly SE. Outcomes and Predictors of Delayed Intervention After Renal Trauma. Am Surg 2024; 90:2170-2175. [PMID: 38605637 DOI: 10.1177/00031348241246164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Historically, a zone II hematoma mandated exploration after penetrating trauma, but this has been challenged given potentially higher nephrectomy rates and the advent of therapeutic endovascular and endoscopic interventions. We hypothesized penetrating mechanism was not a predictor for delayed intervention in the modern era. METHODS This single-center, retrospective study included renal trauma patients from 3/2019 to 6/2022. Our institutional practice is selective exploration of zone II hematomas for active bleeding and expanding hematoma only, regardless of mechanism. Descriptive statistics and multivariable logistic regression (MLR) were performed. RESULTS One-hundred and forty-four patients were identified, with median age 32 years (IQR:23,49), 66% blunt mechanism, and injury severity score 17(IQR:11,26). Forty-three (30%) required operative intervention, and of the 20 that had a zone II exploration, 3 (15%) underwent renorrhaphy and 17 (85%) underwent nephrectomy. Penetrating patients more frequently underwent immediate operative intervention (67%vs10%,P < .0001), required nephrectomy (27%vs5%,P = .0003), and were less likely to undergo pre-intervention CT (51%vs96%,P < .0001) compared to blunt patients. Delayed renal interventions were higher in penetrating (33%vs13%,P = .004) with no difference in mortality or length of stay compared to blunt mechanism. Ureteral stent placement and renal embolization were the most common delayed interventions. On MLR, the only independent predictor for delayed intervention was need for initial operative intervention (OR 3.803;95%CI:1.612-8.975,P = .0023). Four (3%) required delayed nephrectomy, of which only one underwent initial operative intervention without zone 2 exploration. CONCLUSIONS The most common delayed interventions after renal trauma were renal embolization and ureteral stent. Penetrating mechanism was not a predictor of delayed renal intervention in a trauma center that manages zone II retroperitoneal hematomas similarly regardless of mechanism.
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Affiliation(s)
- Megan G Gross
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Dina M Filiberto
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Benjamin H Lehrman
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Emily K Lenart
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Thomas S Easterday
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Andrew J Kerwin
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Saskya E Byerly
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
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Ząbkowski T, Brzozowski R, Durma AD. Renal injuries in conflict zones: a 6-year study of traumatic cases in Afghanistan. Confl Health 2024; 18:6. [PMID: 38183150 PMCID: PMC10770980 DOI: 10.1186/s13031-023-00566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE During hostilities, gunshot wounds are the most common cause of penetrating injuries. In 8-10% of abdominal injuries kidneys are involved. The treatment method include surgical or conservative treatment (fluids + blood components). METHODS Of 1266 combat trauma cases treated during 6 to 14 rotation of the Polish Military Contingent in Afghanistan, we extracted a subgroup of 44 kidney injuries. Corelation of trauma mechanism, PATI score, treatment methods, and outcomes was evaluated. RESULTS Out of the 41 renal injuries, 20 considered left, 18 right, and 3 both kidneys. There were no statistical significancy in injury lateralization (p = 0.669), and no differences regarding side of a trauma and quantity of blood component used for the treatment (p = 0.246). Nephrectomy was performed on 17 patients (13 left vs. 4 right). A significant correlation between PATI score and the need for a nephrectomy (p = 0.027) was confirmed. Penetrating trauma recquired higher number of blood components comparing to blunt trauma (p < 0.001). The renal salvage rate was in study group was 61.36%. The overall survival (OS) rate was 90.25% - 4 patients died due to trauma. CONCLUSIONS The damage side does not result in a statistically significant increase in the need for blood transfusions or differences in the PATI score. The mechanism of trauma does, however, affect the number of blood components required for treatment, particularly in cases of penetrating trauma. With the introduction of proper treatment, the overall survival rate exceeds 90%, even when opting for conservative treatment.
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Affiliation(s)
- Tomasz Ząbkowski
- Department of Urology, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Robert Brzozowski
- Department of General and Oncological Surgery, 5th Military Clinical Hospital with Polyclinic, Cracov, Poland
| | - Adam Daniel Durma
- Department of Endocrinology and Radioisotope Therapy, Miliary Institute of Medicine - National Research Institute, Warsaw, Poland.
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Dilday J, Owattanapanich N, Benjamin ER, Biswas S, Shackelford S, Demetriades D. Injury Patterns and Treatment Strategies in Civilian and Military Isolated Abdominal Gunshot Wounds. World J Surg 2023; 47:2635-2643. [PMID: 37530783 DOI: 10.1007/s00268-023-07132-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Combat-related gunshot wounds (GSW) may differ from those found in civilian trauma centers. Missile velocity, resources, logistics, and body armor may affect injury patterns and management strategies. This study compares injury patterns, management, and outcomes in isolated abdominal GSW between military (MIL) and civilian (CIV) populations. METHODS The Department of Defense Trauma Registry (DoDTR) and TQIP databases were queried for patients with isolated abdominal GSW from 2013 to 2016. MIL patients were propensity score matched 1:3 based on age, sex, and extraabdominal AIS. Injury patterns and in-hospital outcomes were compared. Initial operative management strategies, including selective nonoperative management (SNOM) for isolated solid organ injuries, were also compared. RESULTS Of the 6435 patients with isolated abdominal GSW, 183 (3%) MIL were identified and matched with 549 CIV patients. The MIL group had more hollow viscus injuries (84% vs. 66%) while the CIV group had more vascular injuries (10% vs. 21%) (p < .05 for both). Operative strategy differed, with more MIL patients undergoing exploratory laparotomy (95% vs. 82%) and colectomy (72% vs. 52%) (p < .05 for both). However, no difference in ostomy creation was appreciated. More SNOM for isolated solid organ injuries was performed in the CIV group (34.1% vs. 12.5%; p < 0.05). In-hospital outcomes, including mortality, were similar between groups. CONCLUSIONS MIL abdominal GSW lead to higher rates of hollow viscus injuries compared to CIV GSW. MIL GSW are more frequently treated with resection but with similar ostomy creation compared to civilian GSW. SNOM of solid organ injuries is infrequently performed following MIL GSW.
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Affiliation(s)
- Joshua Dilday
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA
| | - Natthida Owattanapanich
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA
| | - Elizabeth R Benjamin
- Division of Trauma and Surgical Critical Care, Emory University, Grady Health System, Atlanta, GA, USA
| | - Subarna Biswas
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA
| | | | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA.
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Schellenberg M, Owattanapanich N, Emigh B, Nichols C, Dilday J, Ugarte C, Onogawa A, Matsushima K, Martin MJ, Inaba K. Pseudoaneurysm after High-Grade Penetrating Solid Organ Injury and Utility of Delayed CT Angiography. J Am Coll Surg 2023; 237:433-438. [PMID: 37102573 DOI: 10.1097/xcs.0000000000000730] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Leaving an injured solid organ in situ allows preservation of structure function but invites complications from the damaged parenchyma, including pseudoaneurysms (PSAs). Empiric PSA screening after solid organ injury is not yet established, particularly following penetrating trauma. The study objective was definition of delayed CT angiography (dCTA) yield in triggering intervention for PSA after penetrating solid organ injury. METHODS Penetrating trauma patients at our American College of Surgeons-verified level 1 center with American Association for the Surgery of Trauma grade ≥3 abdominal solid organ injury (liver, spleen, kidney) were retrospectively screened (January 2017 to October 2021). Exclusions were age <18 y, transfers, death within <48 h, and nephrectomy/splenectomy within <4 h. Primary outcome was intervention triggered by dCTA. Statistical testing with ANOVA/chi-square compared outcomes between screened vs unscreened patients. RESULTS A total of 136 penetrating trauma patients met study criteria: 57 patients (42%) screened for PSA with dCTA and 79 (58%) unscreened. Liver injuries were most common (n = 41, 64% vs n = 55, 66%), followed by kidney (n = 21, 33% vs n = 23, 27%) and spleen (n = 2, 3% vs n = 6, 7%) (p = 0.48). Median American Association for the Surgery of Trauma grade of solid organ injury was 3 (3 to 4) across groups (p = 0.75). dCTA diagnosed 10 PSAs (18%) at a median of hospital day 5 (3 to 9). Among screened patients, dCTA triggered intervention in 17% of liver patients, 29% of kidney patients, and 0% of spleen-injured patients, for an overall yield of 23%. CONCLUSIONS Half of eligible penetrating high-grade solid organ injuries were screened for PSA with dCTA. dCTA identified a significant number of PSAs and triggered intervention in 23% of screened patients. dCTA did not diagnose any PSAs after splenic injury, although sample size hinders interpretation. To avoid missing PSAs and incurring their risk of rupture, universal screening of high-grade penetrating solid organ injuries may be prudent.
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Affiliation(s)
- Morgan Schellenberg
- From the Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA
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Kanlerd A, Auksornchart K, Boonyasatid P. Non-operative management for abdominal solidorgan injuries: A literature review. Chin J Traumatol 2022; 25:249-256. [PMID: 34654595 PMCID: PMC9459001 DOI: 10.1016/j.cjtee.2021.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 02/04/2023] Open
Abstract
The philosophy of abdominal injury management is currently changing from mandatory exploration to selective non-operative management (NOM). The patient with hemodynamic stability and absence of peritonitis should be managed non-operatively. NOM has an overall success rate of 80%-90%. It also can reduce the rate of non-therapeutic abdominal exploration, preserve organ function, and has been defined as the safest choice in experienced centers. However, NOM carries a risk of missed injury such as hollow organ injury, diaphragm injury, and delayed hemorrhage. Adjunct therapies such as angiography with embolization, endoscopic retrograde cholangiopancreatography with stenting, and percutaneous drainage could increase the chances of successful NOM. This article aims to describe the evolution of NOM and define its place in specific abdominal solid organ injury for the practitioner who faces this problem.
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Affiliation(s)
- Amonpon Kanlerd
- Unit of Trauma and Surgical Critical Care, Division of General Surgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand.
| | - Karikarn Auksornchart
- Unit of Trauma and Surgical Critical Care, Division of General Surgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Piyapong Boonyasatid
- Unit of Trauma and Surgical Critical Care, Division of General Surgery, Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
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Clements TW, Ball CG, Nicol AJ, Edu S, Kirkpatrick AW, Navsaria P. Penetrating renal injuries: an observational study of non-operative management and the impact of opening Gerota's fascia. World J Emerg Surg 2022; 17:35. [PMID: 35725557 PMCID: PMC9208135 DOI: 10.1186/s13017-022-00439-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Non-operative management has become increasingly popular in the treatment of renal trauma. While data are robust in blunt mechanisms, the role of non-operative management in penetrating trauma is less clear. Additionally, there is a paucity of data comparing gunshot and stab wounds. Methods A retrospective review of patients admitted to a high-volume level 1 trauma center (Groote Schuur Hospital, Cape Town) with penetrating abdominal trauma was performed. Patients with renal injuries were identified and compared based on mechanism [gunshot (GSW) vs. stab] and management strategy (operative vs. non-operative). Primary outcomes of interest were mortality and failure of non-operative management. Secondary outcomes of interest were nephrectomy rates, Clavien-Dindo complication rate, hospital length of stay, and overall morbidity rate. Results A total of 150 patients with renal injuries were identified (82 GSW, 68 stab). Overall, 55.2% of patients required emergent/urgent laparotomy. GSWs were more likely to cause grade V injury and concurrent intra-abdominal injuries (p > 0.05). The success rate of non-operative management was 91.6% (89.9% GSW, 92.8% stab, p = 0.64). The absence of hematuria on point of care testing demonstrated a negative predictive value of 98.4% (95% CI 96.8–99.2%). All but 1 patient who failed non-operative management had associated intra-abdominal injuries requiring surgical intervention. Opening of Gerota’s fascia resulted in nephrectomy in 55.6% of cases. There were no statistically significant risk factors for failure of non-operative management identified on univariate logistic regression. Conclusions NOM of penetrating renal injuries can be safely and effectively instituted in both gunshot and stab wounds with a very low number of patients progressing to laparotomy. Most patients fail NOM for associated injuries. During laparotomy, the opening of Gerota’s fascia may lead to increased risk of nephrectomy. Ongoing study with larger populations is required to develop effective predictive models of patients who will fail NOM.
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Affiliation(s)
- Thomas W Clements
- Cumming School of Medicine, University of Calgary, Calgary, Canada.,Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Chad G Ball
- Cumming School of Medicine, University of Calgary, Calgary, Canada.,Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Andrew J Nicol
- Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Sorin Edu
- Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Andrew W Kirkpatrick
- Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, Cape Town, 7925, South Africa
| | - Pradeep Navsaria
- Groote Schuur Hospital, University of Cape Town, Main Road, Observatory, Cape Town, 7925, South Africa.
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Gillams K, Jones P, Hawary A. Conservative management of a patient with a renal gunshot injury. Br J Hosp Med (Lond) 2021; 82:1-2. [PMID: 34338023 DOI: 10.12968/hmed.2020.0743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kathryn Gillams
- Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Patrick Jones
- Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Amr Hawary
- Urology Department, Great Western Hospitals NHS Foundation Trust, Swindon, UK
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Salcedo A, Ordoñez CA, Parra MW, Osorio JD, Leib P, Caicedo Y, Guzmán-Rodríguez M, Padilla N, Pino LF, Herrera MA, Hadad AG, Serna JJ, García A, Coccolini F, Catena F. Damage Control for renal trauma: the more conservative the surgeon, better for the kidney. Colomb Med (Cali) 2021; 52:e4094682. [PMID: 34188325 PMCID: PMC8216050 DOI: 10.25100/cm.v52i2.4682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Urologic trauma is frequently reported in patients with penetrating trauma. Currently, the computerized tomography and vascular approach through angiography/embolization are the standard approaches for renal trauma. However, the management of renal or urinary tract trauma in a patient with hemodynamic instability and criteria for emergency laparotomy, is a topic of discussion. This article presents the consensus of the Trauma and Emergency Surgery Group (CTE) from Cali, for the management of penetrating renal and urinary tract trauma through damage control surgery. Intrasurgical perirenal hematoma characteristics, such as if it is expanding or actively bleeding, can be reference for deciding whether a conservative approach with subsequent radiological studies is possible. However, if there is evidence of severe kidney trauma, surgical exploration is mandatory and entails a high probability of requiring a nephrectomy. Urinary tract damage control should be conservative and deferred, because this type of trauma does not represent a risk in acute trauma management.
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Affiliation(s)
- Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
- Hospital Universitario del Valle Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia
| | - Carlos A Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - José Daniel Osorio
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | | | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Mónica Guzmán-Rodríguez
- Universidad de Chile, Facultad de Medicina, Instituto de Ciencias Biomédicas, Santiago de Chile, Chile
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Hospital Universitario del Valle Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Hospital Universitario del Valle Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia
| | - Adolfo González Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Hospital Universitario del Valle Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - José Julián Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
- Hospital Universitario del Valle Division of Trauma and Acute Care Surgery, Department of Surgery, Cali, Colombia
| | - Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Federico Coccolini
- Pisa University Hospital, Department of General Emergency and Trauma Surgery, Pisa, Italy
| | - Fausto Catena
- Parma Maggiore Hospital, Department of Emergency Surgery, Parma, Italy
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Schellenberg M, Owattanapanich N, Switzer E, Lewis M, Matsushima K, Lam L, Inaba K. Selective Nonoperative Management of Abdominal Shotgun Wounds. J Surg Res 2020; 259:79-85. [PMID: 33279847 DOI: 10.1016/j.jss.2020.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/09/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Selective nonoperative management (SNOM) of abdominal gunshot wounds (GSWs) has not been specifically examined after shotgun injuries. Because of the unpredictable nature of shotgun pellets, it is unclear if SNOM after shotgun wounds is safe. The study objective was to examine outcomes after SNOM for shotgun wounds to the abdomen. METHODS Patients with isolated abdominal shotgun wounds were identified from the National Trauma Data Bank (2007-2017). Transfers, arrival without signs of life, death in the emergency department, severe (Abbreviated Injury Scale ≥3) extra-abdominal injuries, abdominal Abbreviated Injury Scale = 6, and missing data were exclusion criteria. Patients with abdominal handgun wounds (GSWs) were used for comparison. Study groups of shotgun-injured patients were defined by management strategy: operative management (OM) (exploratory laparotomy ≤4h) versus SNOM (no exploratory laparotomy ≤4h). Outcomes were compared by mechanism of injury (shotgun versus GSW) and management strategy (OM versus SNOM) using univariate and multivariate analyses. RESULTS After exclusions, 1425 patients injured by abdominal shotgun wounds were included. Shotgun-injured patients underwent SNOM more frequently than GSW patients (42% versus 34%, P < 0.001). On multivariate analysis, injury by shotgun was independently associated with SNOM (OR 1.443, P = 0.040). Shotgun injuries were significantly more likely to fail SNOM (OR 2.401, P = 0.018). Failure of SNOM occurred earlier among shotgun-than GSW-injured patients (15 versus 24h, P = 0.011). SNOM after shotgun injury was associated with lower mortality than OM, even when patients failed SNOM (P < 0.001). Complications were uniformly higher after OM than SNOM, even when SNOM failed (P < 0.05). CONCLUSIONS SNOM was utilized more commonly after shotgun wounds than GSWs. However, SNOM was more likely to fail after shotgun injury and tended to occur earlier after admission. SNOM after shotgun injury was associated with improved mortality and decreased complication rates when compared with OM, even when patients failed SNOM. SNOM appears to be a safe and beneficial management strategy after shotgun wounds to the abdomen.
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Affiliation(s)
- Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California.
| | - Natthida Owattanapanich
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Emily Switzer
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Meghan Lewis
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Kazuhide Matsushima
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Lydia Lam
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
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