Yusoff, Muhammad Za'im Mohammad
(2021)
Retrospective study on the management of liver trauma: a 7-year experience in a hepatobiliary center.
Masters thesis, Universiti Sains Malaysia.
Abstract
Background: Liver trauma is one of the most common injury in abdominal trauma. For
the last three decades, there was a paradigm shift from operative to non-operative
management (NOM) in liver trauma, with stable haemodynamic, regardless to the grading
of liver injury. There are factors that should be considered for anticipating failure of nonoperative
management. Therefore, this study is performed to identify these factors, to
ensure that early intervention is done in order to achieve less morbidity and mortality in
non-operative management of liver trauma.
Methods: This is a retrospective study of case record of patients diagnosed with liver
injury in Hospital Sultanah Bahiyah, Alor Setar from 1st January 2012 to 31st December
2018. Subjects who met the inclusion criteria were recruited in this study. The outcome
of non-operative management and factors leading to its failure were studied. The data
were analyzed using Statistical Package for the Social Sciences (SPSS) version 26.
Results: A total of 158 patients were included in this study. They were 12 to 80 years
old, with mean age of 25.6 years. The subject pool comprised of 125 males and 33
females. Majority of the liver traumas were due to motor vehicle accidents, 141 (89.2%),
followed by fall, 6 (3.8%) and industrial injury 3 (1.9%). Grade III and grade IV liver
injuries were the two most common grading with a total of 43 (27.2%) and 42 (26.6%)
cases encountered respectively. Fifty-three patients underwent emergency laparotomy
and 20 (37.2%) of them developed post-operative complications. Hundred and five
patients were treated non-operatively. Majority of the patients in this group were young,
mean age of 21.0 years old. Simple logistic regression revealed six predictive factors
associated with failure of NOM, including haemoglobin at presentation (p 0.015), blood
transfusion status (p 0.008), unit of blood transfused (p 0.014), liver injury grade (p 0.001), length of stay (p 0.028) and intensive care unit admission (p 0.041). Multiple
logistic regression shown that liver injury grade and length of stay had significant
association with failure of NOM, with p value of 0.003 and 0.040 respectively.
Conclusion: Non-operative management in liver trauma is a safe approach in
haemodinamically stable patients. Factors related to its failure must be considered for
better outcome in term of morbidity and mortality
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