Non-operative management of blunt hepatic and splenic injury: a time trend and outcome analysis over a period of 17 years in a large European trauma centre

Abstract

Background: Despite a widespread shift to non-operative management (NOM) of blunt injuries to the liver and spleen, detailed data from high-volume centres are limited. We aimed to perform a time-trend analysis over 17 years, evaluate the outcome and identify risk factors for failure of NOM in patients with blunt hepatic and splenic injury. Material and Methods: Retrospective review of all emergency trauma patients at the Medical University of Innsbruck from 2000 to 2016. Injury severity, clinical data on admission, operative and non- operative treatment parameters, complications and in-hospital mortality were evaluated. Results: In total 731 patients were treated with hepatic and/or splenic injuries between 2000-2016. Among these, 368 had liver injury, 280 splenic injury and 83 combined hepatic/splenic injury. Initial NOM for both groups was performed in 82.6% of patients, of which 1.2% received angiographic embolisation and/or ERCP. All other NOM cases were managed through bed rest without primary intervention. The secondary failure rate of NOM was 3.5%. Reasons for failure of NOM were: haemodynamic instability due to persistent or secondary bleeding, extent of intraabdominal heamatoma and infectious complications.Overall mortality rate was below 5% (p<0.0001), in the NOM group 3.5% (p=0.006), both decreasing significantlyover the study period. Conclusion: NOM is the standard of care for blunt hepatic and splenic injuries and successful in >96% of all patients. This rate was quite constant over 17 years (p=0.515). Our cohort represents one of the largest Western European single centre experience available in the literature.