TY - JOUR
T1 - Risk factors for hepatic morbidity following nonoperative management
T2 - Multicenter study
AU - Kozar, Rosemary A.
AU - Moore, Frederick A.
AU - Cothren, C. Clay
AU - Moore, Ernest E.
AU - Sena, Matthew
AU - Bulger, Eileen M.
AU - Miller, Charles C.
AU - Eastridge, Brian
AU - Acheson, Eric
AU - Brundage, Susan I.
AU - Tataria, Monika
AU - McCarthy, Mary
AU - Holcomb, John B.
AU - Jurkovich, Gregory J.
AU - Tyburski, James G.
AU - Peter, Edward T.
AU - Cullinane, Daniel
AU - Smith, Randall W.
PY - 2006/5
Y1 - 2006/5
N2 - Hypothesis: Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified. Design: Multicenter historical cohort. Setting: Seven urban level I trauma centers. Patients: Patients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours. Intervention: Nonoperative treatment of complex blunt hepatic injuries. Main Outcome Measures: Complications and treatment strategies. Results: Of 699 patients with complex blunt hepatic injuries, 453 (65%) were treated nonoperatively. Overall, 61 patients (13%) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1; and bile duct injury, 1), abdominal compartment syndrome (5), and infections (abscess, 7; necrosis, 2; and suspected abdominal sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; interventional radiology drainage, 16; paracentesis, 1; laparotomy, 24; and laparoscopy, 4). Hepatic complications developed in 5% (13 of 264) of patients with grade 3 injuries, 22% (36 of 166) of patients with grade 4 injuries, and 52% (12 of 23) of patients with grade 5 injuries. Univariate analysis revealed 24-hour crystalloid, total and first 24-hour packed red blood cells, fresh frozen plasma, platelet, and cryoprecipitate requirements and liver injury grade to be significant but only liver injury grade (grade 4 odds ratio, 4.439; grade 5 odds ratio, 12.001) and 24-hour transfusion requirement (odds ratio, 6.446) predicted complications by multivariable analysis. Conclusions: Nonoperative management of high-grade liver injuries is associated with significant morbidity and correlates with grade of liver injury. Screening patients with transfusion requirements and high-grade injuries may result in earlier diagnosis and treatment of hepatic-related complications.
AB - Hypothesis: Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified. Design: Multicenter historical cohort. Setting: Seven urban level I trauma centers. Patients: Patients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours. Intervention: Nonoperative treatment of complex blunt hepatic injuries. Main Outcome Measures: Complications and treatment strategies. Results: Of 699 patients with complex blunt hepatic injuries, 453 (65%) were treated nonoperatively. Overall, 61 patients (13%) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1; and bile duct injury, 1), abdominal compartment syndrome (5), and infections (abscess, 7; necrosis, 2; and suspected abdominal sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; interventional radiology drainage, 16; paracentesis, 1; laparotomy, 24; and laparoscopy, 4). Hepatic complications developed in 5% (13 of 264) of patients with grade 3 injuries, 22% (36 of 166) of patients with grade 4 injuries, and 52% (12 of 23) of patients with grade 5 injuries. Univariate analysis revealed 24-hour crystalloid, total and first 24-hour packed red blood cells, fresh frozen plasma, platelet, and cryoprecipitate requirements and liver injury grade to be significant but only liver injury grade (grade 4 odds ratio, 4.439; grade 5 odds ratio, 12.001) and 24-hour transfusion requirement (odds ratio, 6.446) predicted complications by multivariable analysis. Conclusions: Nonoperative management of high-grade liver injuries is associated with significant morbidity and correlates with grade of liver injury. Screening patients with transfusion requirements and high-grade injuries may result in earlier diagnosis and treatment of hepatic-related complications.
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U2 - 10.1001/archsurg.141.5.451
DO - 10.1001/archsurg.141.5.451
M3 - Article
C2 - 16702516
AN - SCOPUS:33646540117
SN - 0004-0010
VL - 141
SP - 451
EP - 459
JO - Archives of Surgery
JF - Archives of Surgery
IS - 5
ER -