Treatment of liver trauma in a military hospital over the past 10 years – Adherence to World Society of Emergency Surgery (WSES) guidelines

Introduction – Traumatic liver injuries (TLI) are a life-threatening condition in oftentimes severely injured patients. Although guideline recommendations changed from a predominantly surgical approach to non-operative management (NOM), surgery is still performed frequently and raises the question of discrepancy. This study aimed to describe the epidemiology of TLI, surgical/NOM procedures performed and the adherence to WSES guidelines in a military teaching hospital.

Materials & Methods – This single center study was conducted at a German military teaching hospital that serves as a Level 1 trauma center. Patients with TLI from 01.01.2013 to 22.10.2024 that received in-hospital treatment were included. Exclusion criteria were iatrogenic TLI. A descriptive analysis was performed.

Results –108 patients with TLI were finally included. Median age was 34.5 years and 60.2 % were male. 78,7 %of TLI were low-grade injuries (AAST I-II°) and only 21,3% involved moderate and major liver lacerations (AAST III-V°). Surgical intervention of a TLI was performed in 42.6 % of the cases with Damage-Control-Surgery (DCS) in 10.2 % cases. Mean operative time for primary surgery was 97.5 minutes. In 86 patients other injuries than TLI needed surgical intervention. Median hospital length of stay was 16.5 days and overall in-hospital mortality was 5.5 %.

Conclusion – The majority of TLI were of low grade, possibly permitting NOM. Nonetheless, liver preserving surgical procedures were common and a DCS approach was seldom needed. Based on our evaluation, there is potential to further reduce surgical interventions in TLI. Nevertheless, concomitant injuries are common with a need for surgical treatment.

References

Coccolini F et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg. 2020Beltzer C et al. Use of angioembolization, treatment modalities and mortality in association with blunt liver trauma in Germany - a data analysis of the TraumaRegister DGU®. Langenbecks Arch Surg. 2023

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