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Titolo:
Blunt hepatic injury: A paradigm shift from operative to nonoperative management in the 1990s
Autore:
Malhotra, AK; Fabian, TC; Croce, MA; Gavin, TJ; Kudsk, KA; Minard, G; Pritchard, FE;
Indirizzi:
Univ Tennessee, Dept Surg, Memphis, TN 38163 USA Univ Tennessee Memphis TN USA 38163 see, Dept Surg, Memphis, TN 38163 USA
Titolo Testata:
ANNALS OF SURGERY
fascicolo: 6, volume: 231, anno: 2000,
pagine: 804 - 811
SICI:
0003-4932(200006)231:6<804:BHIAPS>2.0.ZU;2-M
Fonte:
ISI
Lingua:
ENG
Soggetto:
COMPUTED-TOMOGRAPHY; LIVER INJURIES; TRAUMA; ADULTS; EXPERIENCE; TRENDS; CT;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
24
Recensione:
Indirizzi per estratti:
Indirizzo: Fabian, TC Univ Tennessee, Dept Surg, 956 Court Ave,Rm G228, Memphis, TN 38163 USA Univ Tennessee 956 Court Ave,Rm G228 Memphis TN USA 38163 3 USA
Citazione:
A.K. Malhotra et al., "Blunt hepatic injury: A paradigm shift from operative to nonoperative management in the 1990s", ANN SURG, 231(6), 2000, pp. 804-811

Abstract

Objective To analyze the outcome of hemodynamically stable patients with blunt hepatic injury managed nonoperatively, and to examine the impact of this approach on the outcome of all patients with blunt hepatic injury. Summary Background Data Until recently, operative management has been the standard for liver injury. A prospective trial from the authors' institution had shown that nonoperative management could safely be applied to hemodynamically stable patients with blunt hepatic injury. The present study reviewed the authors' institutional experience with blunt hepatic trauma since that trial and compared the results with prior institutional experience. Methods Six hundred sixty-one patients with blunt hepatic trauma during the 5-year period ending December 1998 were reviewed (NONOP2). The outcomes were compared with two previous studies from this institution: operative 1985 to 1990 (OP) and nonoperative 1993 to 1994 (NONOP1). Results All 168 OP patients were managed operatively. Twenty-four (18%) of136 NONOP1 patients and 101 (15%) of the 661 NONOP2 patients required immediate exploration for hemodynamic instability. Forty-two (7%) patients failed nonoperative management; 20 were liver-related. Liver-related failures of nonoperative management were associated with higher-grade injuries and with larger amounts of hemoperitoneum on computed tomography scanning. Twenty-four-hour transfusions, abdominal infections, and hospital length of stay were all significantly lower in the NONOP1 and NONOP2 groups versus the OP cohort. The liver-related death rate was constant at 4% in the three cohorts over the three time periods. Conclusions Although urgent surgery continues to be the standard for hemodynamically compromised patients with blunt hepatic trauma, there has been aparadigm shift in the management of hemodynamically stable patients. Approximately 85% of all patients with blunt hepatic trauma are stable. In this group, nonoperative management significantly improves outcomes over operative management in terms of decreased abdominal infections, decreased transfusions, and decreased lengths of hospital stay.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/07/20 alle ore 11:56:55