Nonoperative Management (NOM) of most liver injuries impairs the mastery of intraoperative hemostasis

• Published in: The American journal of surgery Vol. 219; no. 3; pp. 462 - 464
• Main Authors: Lee, Solhee, Buck, Joseph R., Ledgerwood, Anna M., Lucas, Charles E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020; Elsevier Limited
• Subjects: Adult; Education, Medical, Graduate; Female; Hemostasis; Hemostasis, Surgical - education; Hemostatics; Humans; Injuries; Injury Severity Score; Laparotomy; Liver; Liver - injuries; Liver transplantation; Male; Management; Mortality; NOM of liver injury; Patients; Resident education; Skills; Stabbings; Teaching hemostatic techniques; Training; Trauma; Traumatology - education; World War I; World War II; Wounds and Injuries - surgery; Wounds and Injuries - therapy; Resident education; Teaching hemostatic techniques; NOM of liver injury
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2019.09.038

Nonoperative management (NOM) of most liver injury (LI) compromises teaching of technical skills required for intraoperative LI hemostasis. This study assesses this void. The records of patients (pts) admitted for LI during two years (1/1/16–12/31/17) were compared to pts treated during two-year intervals for the last six decades. Treatment included NOM, operation only (OR/only), suture (Sut), tractotomy (Tra), dearterialization (HAL), and resection (Res). During 2016/2017, 41 pts had penetrating (23) or blunt (18) LI. Treatment for penetrating LI was NOM (4), OR/only (12), and hemostasis (7) with Sut (3), HAL (1), Tra (1), and Res (2). Treatment for blunt LI was NOM (16) and OR/only (2). 14 residents performed an average of 0.5 procedures. During six decades, LI requiring hemostasis was 121, 114, 30, 48, 17, and 7 per decade. Concomitantly, the percent having NOM or OR/only was 46%, 47%, 62%, 59%, 72%, and 83%. NOM precludes adequate training for hemostasis of LI. Technical proficiency for LI hemostasis requires training in Advanced Trauma Operative Management (ATOM), Advanced Surgical Skills for Exposure in Trauma (ASSET), and rotation through a liver transplant or hepatobiliary service. •Nonoperative management of liver injury likely impairs learning with intraoperative hemostasis.•Training in Advanced Trauma Operative Management and Advanced Surgical Skills for Exposure in Trauma is recommended.•Rotation on a hepatobiliary service will be helpful.