Risk factors for hepatic morbidity following nonoperative management

Multicenter study

Rosemary A. Kozar, Frederick A. Moore, C. Clay Cothren, Ernest E. Moore, Matthew Sena, Eileen M. Bulger, Charles C. Miller, Brian Eastridge, Eric Acheson, Susan I. Brundage, Monika Tataria, Mary McCarthy, John B. Holcomb, Gregory Jurkovich, James G. Tyburski, Edward T. Peter, Daniel Cullinane, Randall W. Smith

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Hypothesis: Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified. Design: Multicenter historical cohort. Setting: Seven urban level I trauma centers. Patients: Patients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours. Intervention: Nonoperative treatment of complex blunt hepatic injuries. Main Outcome Measures: Complications and treatment strategies. Results: Of 699 patients with complex blunt hepatic injuries, 453 (65%) were treated nonoperatively. Overall, 61 patients (13%) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1; and bile duct injury, 1), abdominal compartment syndrome (5), and infections (abscess, 7; necrosis, 2; and suspected abdominal sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; interventional radiology drainage, 16; paracentesis, 1; laparotomy, 24; and laparoscopy, 4). Hepatic complications developed in 5% (13 of 264) of patients with grade 3 injuries, 22% (36 of 166) of patients with grade 4 injuries, and 52% (12 of 23) of patients with grade 5 injuries. Univariate analysis revealed 24-hour crystalloid, total and first 24-hour packed red blood cells, fresh frozen plasma, platelet, and cryoprecipitate requirements and liver injury grade to be significant but only liver injury grade (grade 4 odds ratio, 4.439; grade 5 odds ratio, 12.001) and 24-hour transfusion requirement (odds ratio, 6.446) predicted complications by multivariable analysis. Conclusions: Nonoperative management of high-grade liver injuries is associated with significant morbidity and correlates with grade of liver injury. Screening patients with transfusion requirements and high-grade injuries may result in earlier diagnosis and treatment of hepatic-related complications.

Original languageEnglish (US)
Pages (from-to)451-459
Number of pages9
JournalArchives of Surgery
Volume141
Issue number5
DOIs
StatePublished - May 1 2006
Externally publishedYes

Fingerprint

Multicenter Studies
Morbidity
Liver
Wounds and Injuries
Nonpenetrating Wounds
Odds Ratio
Bile
Laparotomy
Intra-Abdominal Hypertension
Biliary Fistula
Paracentesis
Interventional Radiology
Trauma Centers
Endoscopic Retrograde Cholangiopancreatography
Therapeutics
Bile Ducts
Peritonitis
Laparoscopy
Abscess
Early Diagnosis

ASJC Scopus subject areas

  • Surgery

Cite this

Kozar, R. A., Moore, F. A., Cothren, C. C., Moore, E. E., Sena, M., Bulger, E. M., ... Smith, R. W. (2006). Risk factors for hepatic morbidity following nonoperative management: Multicenter study. Archives of Surgery, 141(5), 451-459. https://doi.org/10.1001/archsurg.141.5.451

Risk factors for hepatic morbidity following nonoperative management : Multicenter study. / Kozar, Rosemary A.; Moore, Frederick A.; Cothren, C. Clay; Moore, Ernest E.; Sena, Matthew; Bulger, Eileen M.; Miller, Charles C.; Eastridge, Brian; Acheson, Eric; Brundage, Susan I.; Tataria, Monika; McCarthy, Mary; Holcomb, John B.; Jurkovich, Gregory; Tyburski, James G.; Peter, Edward T.; Cullinane, Daniel; Smith, Randall W.

In: Archives of Surgery, Vol. 141, No. 5, 01.05.2006, p. 451-459.

Research output: Contribution to journalArticle

Kozar, RA, Moore, FA, Cothren, CC, Moore, EE, Sena, M, Bulger, EM, Miller, CC, Eastridge, B, Acheson, E, Brundage, SI, Tataria, M, McCarthy, M, Holcomb, JB, Jurkovich, G, Tyburski, JG, Peter, ET, Cullinane, D & Smith, RW 2006, 'Risk factors for hepatic morbidity following nonoperative management: Multicenter study', Archives of Surgery, vol. 141, no. 5, pp. 451-459. https://doi.org/10.1001/archsurg.141.5.451
Kozar, Rosemary A. ; Moore, Frederick A. ; Cothren, C. Clay ; Moore, Ernest E. ; Sena, Matthew ; Bulger, Eileen M. ; Miller, Charles C. ; Eastridge, Brian ; Acheson, Eric ; Brundage, Susan I. ; Tataria, Monika ; McCarthy, Mary ; Holcomb, John B. ; Jurkovich, Gregory ; Tyburski, James G. ; Peter, Edward T. ; Cullinane, Daniel ; Smith, Randall W. / Risk factors for hepatic morbidity following nonoperative management : Multicenter study. In: Archives of Surgery. 2006 ; Vol. 141, No. 5. pp. 451-459.
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abstract = "Hypothesis: Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified. Design: Multicenter historical cohort. Setting: Seven urban level I trauma centers. Patients: Patients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours. Intervention: Nonoperative treatment of complex blunt hepatic injuries. Main Outcome Measures: Complications and treatment strategies. Results: Of 699 patients with complex blunt hepatic injuries, 453 (65{\%}) were treated nonoperatively. Overall, 61 patients (13{\%}) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1; and bile duct injury, 1), abdominal compartment syndrome (5), and infections (abscess, 7; necrosis, 2; and suspected abdominal sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; interventional radiology drainage, 16; paracentesis, 1; laparotomy, 24; and laparoscopy, 4). Hepatic complications developed in 5{\%} (13 of 264) of patients with grade 3 injuries, 22{\%} (36 of 166) of patients with grade 4 injuries, and 52{\%} (12 of 23) of patients with grade 5 injuries. Univariate analysis revealed 24-hour crystalloid, total and first 24-hour packed red blood cells, fresh frozen plasma, platelet, and cryoprecipitate requirements and liver injury grade to be significant but only liver injury grade (grade 4 odds ratio, 4.439; grade 5 odds ratio, 12.001) and 24-hour transfusion requirement (odds ratio, 6.446) predicted complications by multivariable analysis. Conclusions: Nonoperative management of high-grade liver injuries is associated with significant morbidity and correlates with grade of liver injury. Screening patients with transfusion requirements and high-grade injuries may result in earlier diagnosis and treatment of hepatic-related complications.",
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AU - Sena, Matthew

AU - Bulger, Eileen M.

AU - Miller, Charles C.

AU - Eastridge, Brian

AU - Acheson, Eric

AU - Brundage, Susan I.

AU - Tataria, Monika

AU - McCarthy, Mary

AU - Holcomb, John B.

AU - Jurkovich, Gregory

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N2 - Hypothesis: Early risk factors for hepatic-related morbidity in patients undergoing initial nonoperative management of complex blunt hepatic injuries can be accurately identified. Design: Multicenter historical cohort. Setting: Seven urban level I trauma centers. Patients: Patients from January 2000 through May 2003 with complex (grades 3-5) blunt hepatic injuries not requiring laparotomy in the first 24 hours. Intervention: Nonoperative treatment of complex blunt hepatic injuries. Main Outcome Measures: Complications and treatment strategies. Results: Of 699 patients with complex blunt hepatic injuries, 453 (65%) were treated nonoperatively. Overall, 61 patients (13%) developed 87 hepatic complications including bleeding (38), biliary (bile peritonitis, 7; bile leak, 9; biloma, 11; biliary-venous fistula, 1; and bile duct injury, 1), abdominal compartment syndrome (5), and infections (abscess, 7; necrosis, 2; and suspected abdominal sepsis, 6), which required 86 multimodality treatments (angioembolization, 32; endoscopic retrograde cholangiopancreatography and stenting, 9; interventional radiology drainage, 16; paracentesis, 1; laparotomy, 24; and laparoscopy, 4). Hepatic complications developed in 5% (13 of 264) of patients with grade 3 injuries, 22% (36 of 166) of patients with grade 4 injuries, and 52% (12 of 23) of patients with grade 5 injuries. Univariate analysis revealed 24-hour crystalloid, total and first 24-hour packed red blood cells, fresh frozen plasma, platelet, and cryoprecipitate requirements and liver injury grade to be significant but only liver injury grade (grade 4 odds ratio, 4.439; grade 5 odds ratio, 12.001) and 24-hour transfusion requirement (odds ratio, 6.446) predicted complications by multivariable analysis. Conclusions: Nonoperative management of high-grade liver injuries is associated with significant morbidity and correlates with grade of liver injury. Screening patients with transfusion requirements and high-grade injuries may result in earlier diagnosis and treatment of hepatic-related complications.

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