1
|
Alanezi T, Altoijry A, Alanazi A, Aljofan Z, Altuwaijri T, Iqbal K, AlSheikh S, Molla N, Altuwaijri M, Aloraini A, Altuwaijri F, Aldossary MY. Management and Outcomes of Traumatic Liver Injury: A Retrospective Analysis from a Tertiary Care Center Experience. Healthcare (Basel) 2024; 12:131. [PMID: 38255020 PMCID: PMC10815392 DOI: 10.3390/healthcare12020131] [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: 10/17/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND although liver injuries are one of the most critical complications of abdominal trauma, choosing when to operate on these injuries is challenging for surgeons worldwide. METHODS We conducted a retrospective analysis of liver injury cases at our institution from 2016 to 2022 to describe the operative and nonoperative management (NOM) outcomes in patients with traumatic liver injuries. Baseline patient characteristics, liver injury details, treatments, and outcomes were analyzed. RESULTS Data from 45 patients (male, 77.8%) were analyzed. The mean age was 29.3 years. Blunt trauma was the most common injury mechanism (86.7%), whereas penetrating injuries were 8.9% of cases. Conservative management was associated with 18.9% of complications. The overall complication rate was 26.7%; delirium and sepsis were the most common (13.3%), followed by acute renal failure (4.4%), pneumonia, biliary leaks, and meningitis/seizures. CONCLUSIONS Notwithstanding its limitations, this retrospective analysis demonstrated that NOM can serve as a safe and effective strategy for hemodynamically stable patients with liver trauma, irrespective of the patient's injury grade. Nevertheless, careful patient selection and monitoring are crucial. Further investigations are necessary to thoroughly evaluate the management of traumatic liver injuries, particularly in the context of multiorgan injuries.
Collapse
Affiliation(s)
- Tariq Alanezi
- College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia (Z.A.)
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
| | - Aued Alanazi
- College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia (Z.A.)
| | - Ziyad Aljofan
- College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia (Z.A.)
| | - Talal Altuwaijri
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
| | - Kaisor Iqbal
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
| | - Sultan AlSheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
| | - Nouran Molla
- Department of Radiology and Medical Imaging, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia;
| | - Mansour Altuwaijri
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia;
| | - Abdullah Aloraini
- Division of General Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia;
| | - Fawaz Altuwaijri
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia;
| | - Mohammed Yousef Aldossary
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia; (T.A.); (K.I.); (S.A.); (M.Y.A.)
- Division of Vascular Surgery, Department of Surgery, Dammam Medical Complex, Dammam 32245, Saudi Arabia
| |
Collapse
|
2
|
Saqib Y. A systematic review of the safety and efficacy of non-operative management in patients with high grade liver injury. Surgeon 2019; 18:165-177. [PMID: 31399317 DOI: 10.1016/j.surge.2019.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 06/09/2019] [Accepted: 07/13/2019] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The liver is the most frequently damaged organ in blunt abdominal trauma. It is widely accepted that hemodynamically stable patients with low-grade liver trauma should be treated with non-operative management, however there is controversy surrounding its safety and efficacy in high-grade trauma. The purpose of this review is to investigate the role of non-operative management in patients with high-grade liver trauma. METHODS PubMed and reference lists of PubMed articles were searched to find studies that examined the efficacy of non-operative management in high-grade liver injury patients, and compare it to operative management. Non-operative management was considered successful if rescue surgery was avoided. Outcomes considered were success, mortality, and complication rates. RESULTS The electronic search revealed 2662 records, 8 of which met the inclusion criteria. All 8 studies contained results suggesting that non-operative management was safe and effective in hemodynamically stable patients with high-grade liver trauma. By combining the outcomes of the different studies, non-operative management had a high success rate of 92.4% (194/210) in high-grade liver trauma patients, which was near the overall 95.0% non-operative management success rate. Non-operative management also had mortality and complication rates of 4.6% (9/194) and 9.7% (7/72) in high-grade injury patients, respectively, compared to operative management's 17.6% (26/148) and 45.5% (5/11). CONCLUSION Non-operative management of liver trauma is safe and effective in hemodynamically stable patients with high-grade liver injury. It is associated with significantly lower mortality compared with operative management. More studies are required to evaluate complications of non-operative management in high-grade liver injury.
Collapse
Affiliation(s)
- Yosuf Saqib
- Saba University School of Medicine, The Bottom, Caribbean Netherlands, the Netherlands.
| |
Collapse
|
3
|
Fodor M, Primavesi F, Morell-Hofert D, Kranebitter V, Palaver A, Braunwarth E, Haselbacher M, Nitsche U, Schmid S, Blauth M, Gassner E, Öfner D, Stättner S. Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years. World J Emerg Surg 2019; 14:29. [PMID: 31236129 PMCID: PMC6580509 DOI: 10.1186/s13017-019-0249-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022] Open
Abstract
Background A widespread shift to non-operative management (NOM) for blunt hepatic and splenic injuries has been observed in most centers worldwide. Furthermore, many countries introduced safety measures to systematically reduce severe traffic and leisure sports injuries. This study aims to evaluate the effect of these nationwide implementations on individual patient characteristics and outcomes through a time-trend analysis over 17 years in an Austrian high-volume trauma center. Methods A retrospective review of all emergency trauma patients admitted to the Medical University of Innsbruck from 2000 to 2016. Injury severity, clinical data on admission, operative and non-operative treatment parameters, complications, and in-hospital mortality were evaluated. Results In total, 731 patients were treated with blunt hepatic and/or splenic injuries. Among these, 368 had a liver injury, 280 splenic injury, and 83 combined hepatic/splenic injury. Initial NOM was performed in 82.6% of all patients (93.5% in hepatic and 71.8% in splenic injuries) with a success rate of 96.7%. The secondary failure rate of NOM was 3.3% and remained consistent over 17 years (p = 0.515). In terms of injury severity, we observed a reduction over time, resulting in an overall mortality rate of 4.8% and 3.5% in the NOM group (decreasing from 7.5 to 1.9% and from 5.6 to 1.3%, respectively). These outcomes confirmed an improved utilization of the NOM approach. Conclusion Our cohort represents one of the largest Central European single-center experiences available in the literature. NOM is the standard of care for blunt hepatic and splenic injuries and successful in > 96% of all patients. This rate was quite constant over 17 years (p = 0.515). Overall, national and regional safety measures resulted in a significantly decreased severity of observed injury patterns and deaths due to blunt hepatic or splenic trauma. Although surgery is nowadays only applied in about one third of splenic injury patients in our center, these numbers might further decrease by intensified application of interventional radiology and modern coagulation management. Electronic supplementary material The online version of this article (10.1186/s13017-019-0249-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Margot Fodor
- 1Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Florian Primavesi
- 1Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | | | - Veronika Kranebitter
- 1Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Anna Palaver
- 1Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Eva Braunwarth
- 1Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Matthias Haselbacher
- 3Department of Trauma Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Ulrich Nitsche
- 4Department of Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Schmid
- 5Department of General and Surgical Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Blauth
- 3Department of Trauma Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Gassner
- 2Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- 1Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Stefan Stättner
- 1Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| |
Collapse
|
4
|
Afifi I, Abayazeed S, El-Menyar A, Abdelrahman H, Peralta R, Al-Thani H. Blunt liver trauma: a descriptive analysis from a level I trauma center. BMC Surg 2018; 18:42. [PMID: 29914487 PMCID: PMC6006727 DOI: 10.1186/s12893-018-0369-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to review liver injury experience in a level 1 trauma center; namely clinical presentation, grading, management approach and clinical outcomes. Methods It is a retrospective analysis to include all blunt liver injury patients who were admitted at the Level 1 trauma center over a 3-year period. Data were compared and analyzed based on the liver injury grades and management approaches. Results Blunt liver injury accounted for 38% of the total blunt abdominal trauma cases with a mean age of 31 ± 13 years. Liver injury grade II (44.7%) was most common followed by grade I (28.8%), grade III (19.1%), grade IV (7.0%) and grade V (0.4%). Blood transfusion was more frequently required in patients with grade IV (p = 0.04). Out of 257 patients with blunt liver trauma, 198 were initially treated conservatively, that was successful in 192 (97%), whereas it failed in 6 (3%) patients due to delayed bleeding from hepatic hematoma, associated splenic rupture and small bowel injury which mandate surgical intervention. Fifty-nine patients (23%) underwent emergent surgery in terms of packing, resection debridement, left lobe hepatectomy and splenectomy. Hepatic complications included biloma, pseudoaneurysm and massive liver necrosis. Subanalysis of data using the World Society of Emergency Surgery (WSES) classification revealed 19 patients were categorized as a WSES grade IV who needed surgical intervention without having an initial computerized tomography scanning. The overall mortality was 7.8% which was comparable among the conservative and operative group. Conclusions In our center, low grade liver injury in young males prevails. NOM is successful even for high graded injuries. All conservatively treated patients with high-grade liver injuries should be closely monitored for signs of failure of the non-operative management. Introducing the new WSES classification makes clear how is important the hemodynamic status of the patients despite the lesion. However, further larger prospective and multicenter studies are needed to support our findings.
Collapse
Affiliation(s)
- Ibrahim Afifi
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| | | | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, HGH, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, PO Box 3050, Doha, Qatar.
| | - Husham Abdelrahman
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| | - Ruben Peralta
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Department of surgery, Trauma Surgery section, Hamad General Hospital (HGH), Doha, Qatar
| |
Collapse
|