Surgical treatment in hepatic trauma: factors associated with hospitalization time

TRINTINALHA, PAULA DE OLIVEIRA; CIRINO, EMANUELLA ROBERNA INÁ; MARCANTE, RENATA FERNANDA RAMOS; JABUR, GABRIEL RAMOS; BUSO, PATRÍCIA LONGHI

doi:10.1590/0100-6991e-20202874

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Original article • Rev. Col. Bras. Cir. 48 • 2021 • https://doi.org/10.1590/0100-6991e-20202874 copy

Surgical treatment in hepatic trauma: factors associated with hospitalization time

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma.

Methods:

retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program.

Results:

most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%.

Conclusions:

the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.

Keywords:
Liver; Wound and Injuries; Abdominal Injuries; Hospitalization Time

Total sample	Outcome hospital discharge (n = 149)	Outcome death (n = 40)	p-Value
Characteristics
Age
Median	28.68	33.83	0.207
Reach	11-63	16-75
Gender
Female	15 (10%)	3 (7.5%)
Male	134 (89.9%)	37 (92.5%)	0.769
Mechanism of trauma
Penetrating trauma	133 (89.3%)	28 (70%)	<0.001
Stabbings	47 (31.5%)	1 (2.5%)
Gunshot wounds	86 (57.7%)	27 (67.5%)
Blunt trauma	16 (10.7%)	12 (30%)
Automobile acidents	12 (8.1%)	9 (22.5%)
Trampling	4 (2.7%)	0
Fall from height	0	3 (7.5%)
Degree of liver injury
Grade I	31 (22.5%)	3 (8.8%)	0.007
Grade II	43 (31.2%)	4 (11.8%)
Grade III	40 (29%)	14 (41.2%)
Grade IV	20 (14.5%)	12 (35.3%)
Grade V	4 (2.9%)	1 (2.9%)
Hepatic lobe
Right	54 (52.9%)	12 (44.4%)	0.592
Left	33 (32.4%)	9 (33.3%)
Both	15 (14.7%)	6 (22.2%)

Topography	Outcome hospital discharge (n =128)	Outcome death n = 37	p-Value
Cervical
Cervical vessels	4 (2.7%)	2 (5%)	0.703
Chest
Chest wall	31 (20.8%)	11 (27.5%)	0.394
Heart	4 (2.7%)	2 (5%)	0.608
Lung	19 (12.8%)	9 (22.5%)	0.136
Esophagus	0	3 (7.5%)	0.009
Diafragm	60 (40.3%)	12 (30%)	0.274
Thoracic vessels	2 (1.3%)	2 (5%)	0.197
Abdomen
Bile duct	7 (4.7%)	6 (15%)	0.033
Spleen	19 (12.8%)	5 (12.5%)	1
Stomach	29 (19.5%)	6 (15%)	0.649
Duodenum	17 (11.4%)	8 (20%)	0.148
Small intestine	21 (14.1%)	15 (37.5%)	0.002
Pancreas	13 (8.7%)	3 (7.5%)	1
Colon	25 (16.8%)	10 (25%)	0.255
Adrenal	0	1 (2.5%)	0.212
Kidneys	27 (18.1%)	8 (20%)	0.820
Ureters	0	1 (2.5%)	0.212
Rectum	1 (0.7%)	0	1
Bladder	2 (1.3%)	1 (2.5%)	0.512
Abdominal vessels	17 (11.4%)	7 (17.5%)	0.295

Variable		ICU length of stay			Hospital length of stay
Variable		n	Average ± SD Median (min-max)	p-Value	n	Average ± SD Median (min-max)	p-Value
Types of lesions	Contusion	16	14.19 ± 13.49 13.5 (0-52)	<0.001*	16	29 ± 23.29 24 (1-78)	0.001*
Types of lesions	Perforant	133	3.5 ± 6.63 0 (0-45)	<0.001*	133	10.44 ± 8.30 8 (2-60)	0.001*
Hemodynamic instability at admission		50	6.92 ± 7.31 4.5 (0-26)	<0.001*	50	16.1 ± 13.76 10 (1-78)	<0.001*
Affected hepatic lobe	Right	54	45.96 ± 8.38 3 (0-39)	0.002**	54	13.76 ± 11.81 9 (1-54)	0.002**
	Left	33	0.88 ± 1.6 0 (0-6)		33	6.30 ± 3.07 6 (2-13)
	Both	15	4 ± 5.03 3 (0-18)		15	15.53 ± 18.13 9 (5-78)
Surgical technique	Hepatorraphy	141	4.26 ± 7.35 0 (0-45)	0.216*	141	11.95 ± 11.29 8 (1-78)	0.376*
	Intrahepatic balloon	4	15.25 ± 17.37 11 (0-39)	0.092*	4	21.75 ± 13.05 19.5 (9-39)	0.045*
	Hepatectomy	4	19.5 ± 22.58 13 (0-52)	0.060*	4	28.00 ± 28.46 17.5 (7-70)	0.086*
	Cauterization	10	7 ± 8.11 4 (0-24)	0.127*	10	12.27 ± 11.8 11 (3-39	0.211*
	Damage control	21	14.38 ± 11.63 1 (2-45)	<0.001*	21	22.90 ± 14.38 17 (5-60)	<0.001*
Occurrence of complications	Yes	44	9.86 ± 10.75 6 (0-52)	<0.001*	44	21.55 ± 16.02 16 (7-78)	<0.001*
Reoperation	Yes	32	12.78 ± 12.68 10.5 (0-52)	<0.001*	32	24.38 ± 17.84 19 (4-78)	<0.001*

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