Multicenter Study of Perioperative Hepatic Angioembolization as an Adjunct for Management of Major Operative Hepatic Trauma.

Abstract

The management of major liver trauma continues to evolve in trauma centers across the United States with increasing use of minimally invasive techniques. Data on the outcomes of these procedures remains minimal. The objective of this study was to evaluate patient complications after perioperative hepatic angioembolization as an adjunct to management of major operative liver trauma. A retrospective multi-institutional study was performed at 13 Level 1 and Level 2 trauma centers from 2012-2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Patients were divided into two groups, ANIGOEMBO and NO ANGIOEMBO. Univariate and multivariate analyses were performed. A total of 442 patients were included with angioembolization performed in 20.4% (n=90/442) of patients. The ANIGOEMBO group was associated with higher rates of biloma formation (p=0.0007), IAA (p=0.04), pneumonia (p=0.006), DVT (p=0.0004), ARF (p=0.004), and ARDS(p=0.0003) and had longer ICU and hospital LOS (p<0.0001). On multivariate analysis, the ANGIOEMBO had a significantly higher amount IAA formation (OR 2.13 95% CI 1.19 -3.99, p=0.02). This is one of the first multicenter studies comparing angioembolization in specifically operative high-grade liver injuries and found that patients with liver injury that undergo angioembolization in addition to surgery have higher rates of both intra and extra-abdominal complications. This provides important information that can guide clinical management.