The Effect of Angioembolization Versus Open Exploration for Moderate to Severe Blunt Liver Injuries on Mortality

• Published in: World journal of surgery Vol. 47; no. 5; pp. 1271 - 1281
• Main Authors: Gallaher, Jared, Burton, Victoria, Schneider, Andrew B., Reid, Trista, Raff, Lauren, Smith, Charlotte B., Charles, Anthony
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2023; Springer Nature B.V
• Subjects: Abbreviated Injury Scale; Abdominal Surgery; Adult; Cardiac Surgery; General Surgery; Humans; Injuries; Injury analysis; Injury Severity Score; Intervention; Liver; Liver - injuries; Medicine; Medicine & Public Health; Morbidity; Mortality; Original Scientific Report; Patients; Retrospective Studies; Surgery; Thoracic Surgery; Trauma; Vascular Surgery; Wounds, Nonpenetrating - complications
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-023-06926-5

Introduction Blunt liver injury is common and is associated with a high morbidity and mortality. More severe injuries often require either angioembolization or open operative repair, depending on patient factors and facility capacity. We sought to describe patient outcomes based on intervention type. Methods We analyzed the National Trauma Data Bank (2017–2019) using ICD-10 codes to identify adult patients with blunt liver injury and their interventions. AIS (Abbreviated Injury Scale) scores were used to group patients based on liver injury severity (AIS 2–6). Logistic regression modeling was used to estimate the adjusted odds ratio of death based on intervention type, excluding patients with severe injury. Results Of 2,848,592 trauma patients, 50,250 patients had a blunt liver injury. Among patients with AIS 3/4/5 injury, 1,140 had angioembolization, 1,529 had an open repair, and 188 had both angioembolization and open repair. In comparison with no intervention and adjusted for age, sex, shock index, ISS, and transfusion total (first four hours), angioembolization was associated with a significant decrease in the odds of mortality for patients with an AIS 4 (OR 0.68, 95% CI 0.47, 0.99) and AIS 5 injury (OR 0.39, 95% CI 0.24, 0.64). In patients with an AIS 5 injury, open repair had an increased odds of mortality at OR 1.99 (95% CI 1.47, 2.69). Conclusion In an analysis of a national trauma database, patients with a moderate to severe injury (AIS 4 or 5), angioembolization was associated with a significant reduction in the adjusted odds of mortality compared to open repair and should be considered when clinically appropriate.