Grade of injury, not initial management, is associated with unplanned interventions in liver injury. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Edalatpour, Armin; Young, Brian T.; Brown, Laura R.; Tseng, Esther S.; Ladhani, Husayn A.; Patel, Nimitt J.; Claridge, Jeffrey A.; Ho, Vanessa P.
• Is Part Of: Injury. Volume 51:Issue 6(2020)
• Page Start: 1301
• Page End: 1305
• Publication Date: 2020-06
• Subjects: Liver injury -- Non-operative management -- Operative management -- Unplanned procedures; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.03.043
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Initial selective non-operative management vs. operative management is not associated with unplanned interventions. Nearly 30% of patients with firearm mechanism of injury require an unplanned intervention for a complication. Nearly 25% of patients with grade IV or v liver injury require an unplanned intervention for a complication. Abstract: Introduction: Risk factors for complications after liver injury do not distinguish between patients undergoing selective non-operative management (sNOM) vs operative management (OM) as the initial treatment strategy. Our objective was to identify risk factors for complications requiring an unplanned intervention following sNOM or OM. We hypothesized that patient undergoing sNOM will have fewer unplanned interventions. Methods: Adults presenting to a level I trauma center with grade III or higher liver injury over a period of 6 years were reviewed. Patient and injury factors, initial management strategy, subsequent complications and interventions were obtained. Bivariate analysis was performed between patients undergoing sNOM vs OM to determine factors associated with unplanned interventions, defined as intervention >48 h after injury. Logistic regression was performed to identify independent risk factors for unplanned interventions. Results: 191 patients were identified: 105 (55%) grade III, 64 (34%) grade IV, and 22 (12%) grade V injury; 136 (71%) underwent sNOM and 55 (29%) underwent OM. 21 (15%) patients required an unplanned intervention: 26 percutaneous drainage, 10 ERCP, and 3 angiography; 12 had multiple procedures. Male gender, younger age, higher ISS, higher grade of injury, firearm mechanism, and initial OM (all p < 0.05) were associated with unplanned interventions. Firearm mechanism and injury grade IV and V, but not initial OM, were independent risk factors for an unplanned intervention. Conclusions: Grade of liver injury, not the initial mode of treatment, was significantly associated with requiring an unplanned intervention for liver-related complications. Surveillance at 7–10 days, or prior to discharge, in the high-risk group may be able to capture those requiring unplanned intervention and readmission.