Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy

Hamidreza Hosseinpour; Adam Nelson; Sai Krishna Bhogadi; Audrey L Spencer; Qaidar Alizai; Christina Colosimo; Tanya Anand; Michael Ditillo; Louis J Magnotti; Bellal Joseph

doi:10.1016/j.amjsurg.2023.06.029

Delayed versus early hepatic resection among patients with severe traumatic liver injuries undergoing damage control laparotomy

Am J Surg. 2023 Dec;226(6):823-828. doi: 10.1016/j.amjsurg.2023.06.029. Epub 2023 Jul 17.

Authors

Affiliations

¹ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
² Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
³ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
⁴ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
⁵ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
⁶ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
⁷ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
⁸ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
⁹ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].
¹⁰ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, USA. Electronic address: [email protected].

PMID: 37543482
DOI: 10.1016/j.amjsurg.2023.06.029

Abstract

Introduction: We aimed to assess the effect of time to hepatic resection on the outcomes of patients with high-grade liver injuries who underwent damage control laparotomy (DCL).

Methods: This is a 4-year (2017-2020) analysis of the ACS-TQIP. Adult trauma patients with severe liver injuries (AAST-OIS grade ≥ III) who underwent DCL and hepatic resection were included. We excluded patients with early mortality (<24 h). Patients were stratified into those who received hepatic resection within the initial operation (Early) and take-back operation (Delayed).

Results: Of 914 patients identified, 29% had a delayed hepatic resection. On multivariable regression analyses, although delayed resection was not associated with mortality (aOR:1.060,95%CI[0.57-1.97],p = 0.854), it was associated with higher complications (aOR:1.842,95%CI[1.38-2.46],p < 0.001), and longer hospital (β: +0.129, 95%CI[0.04-0.22],p = 0.005) and ICU (β:+0.198,95%CI[0.14-0.25],p < 0.001) LOS, compared to the early resection.

Conclusion: Delayed hepatic resection was associated with higher adjusted odds of major complications and longer hospital and ICU LOS, however, no difference in mortality, compared to early resection.

Keywords: Damage control laparotomy; Emergent resection; Hepatic resection; Traumatic liver injuries.

MeSH terms

Abdominal Injuries*
Adult
Humans
Laparotomy* / adverse effects
Liver / injuries
Liver / surgery
Retrospective Studies
Treatment Outcome