Brooks Adam, Joyce Danielle, La Valle Angelo, Reilly John-Joe, Blackburn Lauren, Kitchen Samuel, Morris Louise, Naumann David N
Major Trauma Department, East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, United Kingdom.
Institute of Inflammation and Ageing, University of Aberdeen, Aberdeen, United Kingdom.
Front Surg. 2023 Feb 24;10:1124682. doi: 10.3389/fsurg.2023.1124682. eCollection 2023.
Centralisation of trauma care has been shown to be associated with improved patient outcomes. The establishment of Major Trauma Centres (MTC) and networks in England in 2012 allowed for centralisation of trauma services and specialties including hepatobiliary surgery. We aimed to investigate the outcomes for patients with hepatic injury over the last 17 years at a large MTC in England in relation to the MTC status of the centre.
All patients who sustained liver trauma between 2005 and 2022 were identified using the Trauma Audit and Research Network database for a single MTC in the East Midlands. Mortality and complications were compared between patients before and after establishment of MTC status. Multivariable logistic regression models were used to determine the odds ratio (OR) and 95% confidence interval (95% CI) for complications according to MTC status, accounting for the potentially confounding variables of age, sex, severity of injuries and comorbidities for all patients, and the subgroup with severe liver trauma (AAST Grade IV and V).
There were 600 patients; the median age was 33 (IQR 22-52) years and 406/600 (68%) were male. There were no significant differences in 90-day mortality or length of stay between the pre- and post-MTC patients. Multivariable logistic regression models showed both lower overall complications [OR 0.24 (95% CI 0.14, 0.39); < 0.001] and lower liver-specific complications [OR 0.21 (95% CI 0.11, 0.39); < 0.001] in the post-MTC period. This was also the case in the severe liver injury subgroup (= 0.008 and = 0.002 respectively).
Outcomes for liver trauma were superior in the post-MTC period even when adjusted for patient and injury characteristics. This was the case even though patients in this period were older with more comorbidities. These data support the centralisation of trauma services for those with liver injuries.
创伤护理的集中化已被证明与改善患者预后相关。2012年在英格兰设立的重大创伤中心（MTC）和网络使得创伤服务及包括肝胆外科在内的专科得以集中化。我们旨在调查过去17年里英格兰一家大型MTC中肝损伤患者的预后情况，并将其与该中心的MTC状态相关联。
利用创伤审计与研究网络数据库，识别出2005年至2022年间在东米德兰兹郡一家单一MTC中遭受肝创伤的所有患者。比较了MTC状态确立前后患者的死亡率和并发症情况。使用多变量逻辑回归模型，根据MTC状态确定并发症的比值比（OR）和95%置信区间（95%CI），同时考虑所有患者以及严重肝创伤亚组（美国创伤外科学会IV级和V级）的年龄、性别、损伤严重程度和合并症等潜在混杂变量。
共有600例患者；中位年龄为33岁（四分位间距22 - 52岁），406/600（68%）为男性。MTC状态确立前后的患者在90天死亡率或住院时间方面无显著差异。多变量逻辑回归模型显示，在MTC状态确立后，总体并发症[OR 0.24（95%CI 0.14，0.39）；<0.001]和肝脏特异性并发症[OR 0.21（95%CI 0.11，0.39）；<0.001]均较低。严重肝损伤亚组的情况也是如此（分别为=0.008和=0.002）。
即使对患者和损伤特征进行调整后，MTC状态确立后的肝创伤预后仍更佳。即便这一时期的患者年龄更大且合并症更多，情况依然如此。这些数据支持对肝损伤患者的创伤服务进行集中化。
