Influence of Postoperative Hepatic Angiography on Mortality after Laparotomy in Grade IV/V Hepatic Injuries

Background Mortality rate for severe liver injuries remains high. As an adjunct to surgery, postoperative hepatic angiography (PHA) may have a positive impact on outcomes. This study sought to compare outcomes following surgical management of severe liver injuries with and without PHA using propensity score matching analysis. Methods Data from the National Trauma Data Bank from 2007 – 2014 was analyzed. The study population consisted of patients greater than 18 years of age sustaining severe liver injuries (ie AAST-OIS grade IV or V) who underwent surgery. Patients were divided into two groups. The PHA group consisted of those undergoing surgery followed by PHA. In the surgery only group, no angiography was performed. To determine the impact of PHA on outcomes, propensity score matching analysis (1:3) was utilized. Results A total of 3,871 patients met inclusion criteria. Of those, 205 patients (5.3%) underwent PHA. Prior to matching, patients in the PHA group had higher severity, but overall in-hospital mortality was found to be similar between the two groups. After 1:3 propensity-score matching, 196 patients in the PHA group were matched with 588 in the surgery only group with well-balanced baseline characteristics. The in-hospital mortality was significantly lower in the PHA group compared with the surgery only group (24.5% vs 35.9%; Odds ratio, 0.58; 95% CI: 0.40-0.84). However, hospital length of stay was longer (16.0 [7.0-29.8] vs 11 [1.0-25.0] days, P = 0.001) and the incidence of deep and organ/space surgical site infection (3.6% vs. 1.2%, 8.2% vs. 3.5%, respectively) was higher in the PHA group. Conclusion The use of PHA was associated with decreased mortality rates. A multimodality approach utilizing both surgical intervention followed by PHA appears to identify patients that may benefit from arterial embolization leading to decreased mortality of severe liver injuries. Level of Evidence therapeutic study, level III This study was presented as a quick shot at the 76th Annual Meeting of the AAST, held in Baltimore, Maryland, September 9-12, 2017. Corresponding author: Raul Coimbra, MD, PhD, FACS, Surgeon-in-Chief, Executive Administration, Riverside University Health System Medical Center, Professor of Surgery, Loma Linda University School of Medicine, 26520 Cactus Avenue, Moreno Valley, CA 92555, e-mail: raulcoimbra62@yahoo.com, r.coimbra@ruhealth.org Conflicts of interest and disclosures of funding None of the authors have any sources of funding or conflicts of interest regarding any of the materials used in this study. © 2018 Lippincott Williams & Wilkins, Inc.

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