Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: Trauma surgeons still need to operate, but angioembolization helps

Juan A. Asensio, Gustavo Roldín, Patrizio Petrone, Esther Rojo, Areti Tillou, Eric Kuncir, Demetrios Demetriades, George Velmahos, James Murray, William C. Shoemaker, Thomas V. Berne, Linda Chan

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127 Scopus citations

Abstract

Background: American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality. Methods: This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively. Statistical analysis was performed using univariate and multivariate logistic regression. The main outcome measure was survival. Results: The study included 103 patients, with a mean Revised Trauma Score of 5.61 ± 2.55 and a mean Injury Severity Score of 33 ± 9.5. Mechanism of injury was penetrating in 80 (79%) and blunt in 23 (21%). Emergency department thoracotomy was performed in 21 (25%). AAST grade IV injuries occurred in 51 (47%) and grade V injuries occurred in 52 (53%). Mean estimated blood loss was 9,414 mL. Overall survival was 43%. Adjusted overall survival rate after emergency department thoracotomy patients were excluded was 58%. Results stratified to AAST-OIS injury grade were as follows: grade IV, 32 of 51 (63%); grade V, 12 of 52 (23%); grade IV versus grade V (p <0.001) odds ratio, 2.06; 95% confidence interval, 2.72 (1.40-3.04). Logistic regression analysis identified as independent predictors of outcome Revised Trauma Score (adjusted p <0.0002), angioembolization (adjusted p <0.0177), direct approach to hepatic veins (adjusted p <0.0096), and packing (adjusted p <0.0013). Conclusion: Improvements in mortality can be achieved with an appropriate operative approach. Angioembolization as an adjunct procedure decreases mortality in AAST-OIS grades IV and V hepatic injuries.

Original languageEnglish (US)
Pages (from-to)647-654
Number of pages8
JournalJournal of Trauma
Volume54
Issue number4
DOIs
StatePublished - Apr 2003
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

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