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Published on: July 28, 2020
Embolization versus Surgery for Stabilized Patients with Solid Organ Injury
Makoto Aoki1, Toshikazu Abe2, Shuichi Hagiwara3
1Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan; Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
Purpose:
To compare embolization with laparotomy for the management of hemodynamically unstable patients with solid organ injury who responded to initial resuscitation.
Materials And Methods:
Data from a Japanese nationwide trauma registry were analyzed. Included were hemodynamically unstable patients (systolic blood pressure <90 mm Hg and blood transfusion within the first 24 hours) whose initial computed tomography assessment confirmed the presence of solid organ injuries (liver and/or spleen). A total of 224 patients were included (median age: 53 years, interquartile range: 32-69; 73.3% male; liver injury = 131 [58%] and spleen injury = 98 [44%]; median organ injury scale: 3, interquartile range: 3-4; median injury severity score: 19, interquartile range: 16-25). Patients who underwent embolization were compared with those who underwent laparotomy. The primary outcome was in-hospital survival. The data were evaluated using a propensity score matching analysis.
Results:
Laparotomy and embolization were performed in 133 (59.1%) and 91 (40.4%) patients, respectively. Of those, 111 (84%) and 84 (92%) patients achieved in-hospital survival after laparotomy and embolization, respectively. No significant difference in in-hospital survival (P = .053) was noted. The propensity score matching model did not reveal a significant difference in in-hospital survival (P = .276).
Conclusions:
No significant difference was observed between embolization and laparotomy in terms of in-hospital survival among unstable patients who responded to initial resuscitation with solid organ injury.
