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Table 3 Management of blunt hepatic and splenic injuries

From: Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

  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%)
  1. OM operative management, NOM non-operative management, ERCP endoscopic retrograde cholangiopancreatography, SD standard deviation, MOF multiorgan failure