Outcomes following non-operative management for severe liver trauma: a UK multicentre observational study

Patients with severe liver injury may carry a high risk of complications with significant mortality. Non-operative management (NOM) is increasingly common for severe injuries and may be associated with lower morbidity when compared with surgery.

To evaluate the incidence of NOM for severe liver trauma (American Association for the Surgery of Trauma (AAST) Grade IV and V) and compare outcomes for NOM vs operative management.

All patients admitted between 2012-2022 with severe liver trauma to Birmingham and Nottingham Major Trauma Centres (MTCs) were identified from a validated dataset. Outcomes were compared between those managed by surgery vs treated by NOM. Adjusted multivariable logistic regression models were used to determine the odds ratio (OR) and 95% confidence interval (95% CI) for surgical management, survival rates, and development of liver-specific complications (adjusting for age, sex, ISS, AAST grade, polytrauma).

There were 190 patients; median age 28 years (IQR 20-41); 134 (71%) were male. Median ISS was 27 (IQR 17-41). Overall mortality was 7% (14/190). 122/190 (64%) patients were managed initially by NOM, with only 8/122 (7%) requiring subsequent surgery. Multivariable logistic regression models showed higher ISS, lower SBP on admission, Grade V injuries and penetrating trauma to be independent predictors for surgical treatment. 34/190(18%) patients had liver-specific complications. There was no difference between NOM and operative management groups for 30-day mortality (p = 0.145), but patients in the NOM group had shorter ICU (p < 0.001) and total lengths of stay (p < 0.001) compared to the operative group.

In this modern MTC setting, a high proportion of patients with severe liver trauma were managed by NOM with a low failure rate. Overall mortality rate was low, but liver-specific complications were common. These data support the evolution of traumatic liver injury management in the UK and favour NOM even in severe liver injuries where patient physiology allows.

This study was approved by Nottingham University Hospital Clinical Audit Team (ID Reference 22-709C) and University Hospitals Birmingham NHS Foundation Trust Clinical Audit Registration and Management System (ID Reference CARMS 19146). Consent for participation in the study was not obtained as this was a large retrospective audit with anonymised data.

Level III.