High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach
Background Operative mortality for high-grade liver injury (HGLI) remains 42% to 66%, with near-universal mortality after retrohepatic caval injury. The objective of this study was to evaluate mortality and complications of operative and nonoperative management (OM and NOM) of HGLI at our institutio...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-01-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/10/1/e001611.full |
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| author | J Wallis Marsh Abhinav Humar Jason L Sperry David A Geller Deepika Mohan Timothy R Billiar Juan Carlos Puyana Brian Zuckerbraun Joshua B Brown Matthew D Neal Matthew R Rosengart David Newhouse Christine Leeper Andrew B Peitzman Raquel Forsythe Rafael G Ramos-Jimenez Andrew-Paul Deeb Evelyn I Truong Sowmya Narayanan Louis Alarcon Graciela M Bauza Vaishali Dixit Schuchert Gregory Watson Amit D Tevar |
| author_facet | J Wallis Marsh Abhinav Humar Jason L Sperry David A Geller Deepika Mohan Timothy R Billiar Juan Carlos Puyana Brian Zuckerbraun Joshua B Brown Matthew D Neal Matthew R Rosengart David Newhouse Christine Leeper Andrew B Peitzman Raquel Forsythe Rafael G Ramos-Jimenez Andrew-Paul Deeb Evelyn I Truong Sowmya Narayanan Louis Alarcon Graciela M Bauza Vaishali Dixit Schuchert Gregory Watson Amit D Tevar |
| author_sort | J Wallis Marsh |
| collection | DOAJ |
| description | Background Operative mortality for high-grade liver injury (HGLI) remains 42% to 66%, with near-universal mortality after retrohepatic caval injury. The objective of this study was to evaluate mortality and complications of operative and nonoperative management (OM and NOM) of HGLI at our institution, characterized by a trauma surgery–liver surgery collaborative approach to trauma care.Methods This was an observational cohort study of adult patients (age ≥16) with HGLI (The American Association for Surgery of Trauma (AAST) grades IV and V) admitted to an urban level I trauma center from January 2010 to November 2021. Data were obtained from the electronic medical record and state trauma registry. Patients were categorized by management strategy: immediate OM or planned NOM. The primary outcome was 30-day mortality.Results Our institution treated 179 patients with HGLI (78% blunt, 22% penetrating); 122 grade IV (68%) and 57 grade V (32%) injuries. All abdominal gunshot wounds and 49% of blunt injuries underwent initial OM; 51% of blunt injuries were managed initially by NOM. Procedures at the initial operation included hepatorrhaphy±packing (66.4%), nonanatomic resection (5.6%), segmentectomy (9.3%), and hepatic lobectomy (7.5%). Thirty-day mortality in the OM group was substantially lower than prior reports (23.4%). Operative mortality attributable to the liver injury was 15.7%. 19.4% of patients failed NOM with one death (1.4%).Conclusion We report an operative mortality of 23.4% for HGLI in a trauma care system characterized by a collaborative approach by trauma surgeons and liver surgeons.Level of evidence III |
| format | Article |
| id | doaj-art-fbbe1641964f462d93a31326d5ee464d |
| institution | Kabale University |
| issn | 2397-5776 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-fbbe1641964f462d93a31326d5ee464d2025-02-07T00:10:10ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762025-01-0110110.1136/tsaco-2024-001611High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approachJ Wallis Marsh0Abhinav Humar1Jason L Sperry2David A Geller3Deepika Mohan4Timothy R Billiar5Juan Carlos Puyana6Brian Zuckerbraun7Joshua B Brown8Matthew D Neal9Matthew R Rosengart10David Newhouse11Christine Leeper12Andrew B Peitzman13Raquel Forsythe14Rafael G Ramos-Jimenez15Andrew-Paul Deeb16Evelyn I Truong17Sowmya Narayanan18Louis Alarcon19Graciela M Bauza20Vaishali Dixit Schuchert21Gregory Watson22Amit D Tevar23West Virginia University Health Sciences, Morgantown, West Virginia, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USADepartment of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USAUniversity of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USASurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USABackground Operative mortality for high-grade liver injury (HGLI) remains 42% to 66%, with near-universal mortality after retrohepatic caval injury. The objective of this study was to evaluate mortality and complications of operative and nonoperative management (OM and NOM) of HGLI at our institution, characterized by a trauma surgery–liver surgery collaborative approach to trauma care.Methods This was an observational cohort study of adult patients (age ≥16) with HGLI (The American Association for Surgery of Trauma (AAST) grades IV and V) admitted to an urban level I trauma center from January 2010 to November 2021. Data were obtained from the electronic medical record and state trauma registry. Patients were categorized by management strategy: immediate OM or planned NOM. The primary outcome was 30-day mortality.Results Our institution treated 179 patients with HGLI (78% blunt, 22% penetrating); 122 grade IV (68%) and 57 grade V (32%) injuries. All abdominal gunshot wounds and 49% of blunt injuries underwent initial OM; 51% of blunt injuries were managed initially by NOM. Procedures at the initial operation included hepatorrhaphy±packing (66.4%), nonanatomic resection (5.6%), segmentectomy (9.3%), and hepatic lobectomy (7.5%). Thirty-day mortality in the OM group was substantially lower than prior reports (23.4%). Operative mortality attributable to the liver injury was 15.7%. 19.4% of patients failed NOM with one death (1.4%).Conclusion We report an operative mortality of 23.4% for HGLI in a trauma care system characterized by a collaborative approach by trauma surgeons and liver surgeons.Level of evidence IIIhttps://tsaco.bmj.com/content/10/1/e001611.full |
| spellingShingle | J Wallis Marsh Abhinav Humar Jason L Sperry David A Geller Deepika Mohan Timothy R Billiar Juan Carlos Puyana Brian Zuckerbraun Joshua B Brown Matthew D Neal Matthew R Rosengart David Newhouse Christine Leeper Andrew B Peitzman Raquel Forsythe Rafael G Ramos-Jimenez Andrew-Paul Deeb Evelyn I Truong Sowmya Narayanan Louis Alarcon Graciela M Bauza Vaishali Dixit Schuchert Gregory Watson Amit D Tevar High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach Trauma Surgery & Acute Care Open |
| title | High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach |
| title_full | High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach |
| title_fullStr | High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach |
| title_full_unstemmed | High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach |
| title_short | High-grade liver injury: outcomes with a trauma surgery–liver surgery collaborative approach |
| title_sort | high grade liver injury outcomes with a trauma surgery liver surgery collaborative approach |
| url | https://tsaco.bmj.com/content/10/1/e001611.full |
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