1Department of Visceral, Transplantation and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
2Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
World J Emerg Surg. 2019 Jun 17;14:29. doi: 10.1186/s13017-019-0249-y. eCollection 2019.
A widespread shift to non-operative management (NOM) for blunt hepatic and splenic injuries has been observed in most centers worldwide. Furthermore, many countries introduced safety measures to systematically reduce severe traffic and leisure sports injuries. This study aims to evaluate the effect of these nationwide implementations on individual patient characteristics and outcomes through a time-trend analysis over 17 years in an Austrian high-volume trauma center.
A retrospective review of all emergency trauma patients admitted to 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.
In total, 731 patients were treated with blunt hepatic and/or splenic injuries. Among these, 368 had a liver injury, 280 splenic injury, and 83 combined hepatic/splenic injury. Initial NOM was performed in 82.6% of all patients (93.5% in hepatic and 71.8% in splenic injuries) with a success rate of 96.7%. The secondary failure rate of NOM was 3.3% and remained consistent over 17 years ( = 0.515). In terms of injury severity, we observed a reduction over time, resulting in an overall mortality rate of 4.8% and 3.5% in the NOM group (decreasing from 7.5 to 1.9% and from 5.6 to 1.3%, respectively). These outcomes confirmed an improved utilization of the NOM approach.
Our cohort represents one of the largest Central European single-center experiences available in the literature. 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 ( = 0.515). Overall, national and regional safety measures resulted in a significantly decreased severity of observed injury patterns and deaths due to blunt hepatic or splenic trauma. Although surgery is nowadays only applied in about one third of splenic injury patients in our center, these numbers might further decrease by intensified application of interventional radiology and modern coagulation management.
在世界范围内，大多数中心已广泛采用非手术治疗（NOM）治疗钝性肝脾损伤。此外，许多国家引入了安全措施，以系统减少严重的交通和休闲运动损伤。本研究旨在通过在奥地利一家大容量创伤中心进行的 17 年时间趋势分析，评估这些全国性实施对个体患者特征和结果的影响。
回顾性分析 2000 年至 2016 年期间入住因斯布鲁克医科大学的所有急诊创伤患者。评估损伤严重程度、入院时的临床数据、手术和非手术治疗参数、并发症和院内死亡率。
共有 731 例患者接受了钝性肝脾损伤治疗。其中 368 例为肝损伤，280 例为脾损伤，83 例为肝脾联合损伤。所有患者中，初始 NOM 治疗的比例为 82.6%（肝损伤为 93.5%，脾损伤为 71.8%），成功率为 96.7%。NOM 的继发失败率为 3.3%，且在 17 年内保持不变（=0.515）。就损伤严重程度而言，我们观察到随着时间的推移有所降低，导致总体死亡率为 4.8%，NOM 组为 3.5%（分别从 7.5%降至 1.9%，从 5.6%降至 1.3%）。这些结果证实了 NOM 方法的应用得到了改善。
我们的队列代表了文献中可获得的最大的中欧单中心经验之一。NOM 是治疗钝性肝脾损伤的标准方法，在所有患者中的成功率超过 96%。在 17 年内，这一比例相当稳定（=0.515）。总体而言，国家和地区安全措施导致因钝性肝或脾创伤导致的损伤模式和死亡严重程度显著降低。虽然在我们中心，现在只有约三分之一的脾损伤患者需要手术治疗，但通过强化介入放射学和现代凝血管理的应用，这些数字可能会进一步下降。
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