Angioembolization versus preperitoneal packing for severe pelvic fractures: A propensity matched analysis

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Orthopedic Surgery

Background:

• The association between angioembolization (AE) and preperitoneal pelvic packing (PPP) with survival in hemodynamically unstable pelvic fractures is debated.
• Severe pelvic fractures pose significant mortality risks.

Purpose of the Study:

• To compare the in-hospital survival rates of patients with severe pelvic fractures undergoing AE versus PPP.
• To evaluate the impact of AE and PPP on survival in hemodynamically unstable patients.

Main Methods:

• Retrospective cohort study utilizing the American College of Surgeons Trauma Quality Improvement Program (2016-2018).
• Included patients >16 years with severe pelvic fractures (AIS 3-5) undergoing AE or PPP.
• Propensity-score matching (PSM) analysis was used to compare outcomes.
• Primary outcome was in-hospital survival.

Main Results:

• 1123 patients met inclusion criteria; 964 (85.8%) received AE and 159 (14.2%) received PPP.
• Hemorrhage control laparotomy was more frequent in the PPP group (82.4%) compared to the AE group (25.6%).
• In 220 PSM patients, in-hospital mortality rates did not differ significantly between AE (30.9%) and PPP (38.2%) groups (P=0.321).

Conclusions:

• Despite differing patient characteristics, propensity-matched severe pelvic fracture patients showed no significant difference in in-hospital survival between AE and PPP.
• PPP was more frequently indicated for severe pelvic fractures requiring laparotomy.