Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy - 22/11/23
, Adam Nelson , Sai Krishna Bhogadi , Audrey L. Spencer , Qaidar Alizai , Christina Colosimo , Tanya Anand , Michael Ditillo , Louis J. Magnotti , Bellal Joseph ⁎ Abstract |
Introduction |
We aimed to assess the effect of time to hepatic resection on the outcomes of patients with high-grade liver injuries who underwent damage control laparotomy (DCL).
Methods |
This is a 4-year (2017–2020) analysis of the ACS-TQIP. Adult trauma patients with severe liver injuries (AAST-OIS grade ≥ III) who underwent DCL and hepatic resection were included. We excluded patients with early mortality (<24 h). Patients were stratified into those who received hepatic resection within the initial operation (Early) and take-back operation (Delayed).
Results |
Of 914 patients identified, 29% had a delayed hepatic resection. On multivariable regression analyses, although delayed resection was not associated with mortality (aOR:1.060,95%CI[0.57–1.97],p = 0.854), it was associated with higher complications (aOR:1.842,95%CI[1.38–2.46],p < 0.001), and longer hospital (β: +0.129, 95%CI[0.04–0.22],p = 0.005) and ICU (β:+0.198,95%CI[0.14–0.25],p < 0.001) LOS, compared to the early resection.
Conclusion |
Delayed hepatic resection was associated with higher adjusted odds of major complications and longer hospital and ICU LOS, however, no difference in mortality, compared to early resection.
Le texte complet de cet article est disponible en PDF.Highlights |
• | The rate of mortality and morbidity for high-grade liver injuries remains high. |
• | There is a lack of data on the effect of hepatic resection timing on the outcomes. |
• | There was no association between mortality and timing of hepatic resection. |
• | Early hepatic resection is associated with improved outcomes. |
• | High-grade liver injury management Guidelines should be reevaluated. |
Keywords : Traumatic liver injuries, Damage control laparotomy, Hepatic resection, Emergent resection
Plan
Vol 226 - N° 6
P. 823-828 - décembre 2023 Retour au numéro
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