Table 3 Management of blunt hepatic and splenic injuries
Overall cohort (2000–2016) n = 731 | Early period (2000–2008) n = 372 | Late period (2009–2016) n = 359 | Difference between periods P | |
|---|---|---|---|---|
Primary therapy | ||||
OM | 127 (17.4%) | 69 (18.5%) | 58 (16.2%) | 0.393 |
NOM | 604 (82.6%) | 303 (81.5%) | 301 (83.8%) | |
NOM rate according to the injured organ | ||||
NOM splenic injury | 201 (71.8%) | 85 (69.1%) | 116 (73.9%) | 0.378 |
NOM hepatic injury | 344 (93.5%) | 177 (92.2%) | 167 (94.9%) | 0.295 |
NOM combined splenic and hepatic injury | 59 (71.1%) | 41 (71.9%) | 18 (69.2%) | 0.801 |
Surgical procedures (% of all patients) | ||||
Spleen | ||||
Complete splenectomy | 79 (10.8%) | 41 (11%) | 38 (10.6%) | 0.966 |
Spleen-conserving procedures (suture, hemostasis, etc.) | 17 (2.3%) | 9 (2.4%) | 8 (2.2%) | |
Liver | ||||
Hepatic partial resection | 8 (1.1%) | 5 (1.3%) | 3 (0.8%) | 0.113 |
Liver-conserving procedure (suture, hemostasis, etc.) | 34 (4.7%) | 23 (6.2%) | 11 (3.1%) | |
Angiography or ERCP in case of primary NOM | 9 (1.2%) | 2 (0.5%) | 7 (2.0%) | 0.194 |
Failure NOM (secondary operative, % of NOM) | 20 (3.3%) | 11 (3.6%) | 9 (3%) | 0.515 |
Cause for the failure of NOM (% of all NOM) | ||||
Persistent or secondary bleeding/hemodynamic instability | 13 (65%) | 5 (45.5%) | 8 (88.9%) | 0.123 |
Extent of intra-abdominal hematoma (compression/compartment) | 5 (25%) | 4 (36.4%) | 1 (11.1%) | |
Infectious complications (bile duct injury, sepsis, MOF) | 2 (10%) | 3 (18.2%) | 0 (0%) | |
Management of failed NOM (% of all failed NOM) | ||||
Splenectomy | 11 (55%) | 5 (45.5%) | 6 (66.7%) | 0.517 |
Spleen-conserving surgery | 2 (10%) | 2 (18.2%) | 0 (0%) | |
Liver resection | 3 (15%) | 1 (9.1%) | 2 (22.2%) | |
Non-resection liver surgery (suture, hemostatics, etc.) | 4 (20%) | 3 (27.3%) | 1 (11.1%) | |