Abstract：
BACKGROUND: One of the significant complications of operative liver trauma is intra-abdominal abscesses (IAA). The objective of this study was to determine risk factors associated with postoperative IAA in surgical patients with major operative liver trauma.
METHODS: A retrospective multi-institutional study was performed at 13 Level 1 and Level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Univariate and multivariate analyses were performed.
RESULTS: Three hundred seventy-two patients were included with 21.2% (n = 79/372) developing an IAA. No difference was found for age, gender, injury severity score, liver injury grade, and liver resections in patients between the groups (P > 0.05). Penetrating mechanism of injury (odds ratio (OR) 3.42, 95% confidence interval (CI) 1.54-7.57, P = 0.02), intraoperative massive transfusion protocol (OR 2.43, 95% CI 1.23-4.79, P = 0.01), biloma/bile leak (OR 2.14, 95% CI 1.01-4.53, P = 0.04), hospital length of stay (OR 1.04, 95% CI 1.02-1.06, P < 0.001), and additional intra-abdominal injuries (OR 2.27, 95% CI 1.09-4.72, P = 0.03) were independent risk factors for IAA. Intra-abdominal drains, damage control laparotomy, total units of packed red blood cells, number of days with an open abdomen, total abdominal surgeries, and blood loss during surgery were not found to be associated with a higher risk of IAA.
CONCLUSIONS: Patients with penetrating trauma, massive transfusion protocol activation, longer hospital length of stay, and injuries to other intra-abdominal organs were at higher risk for the development of an IAA following operative liver trauma. Results from this study could help to refine existing guidelines for managing complex operative traumatic liver injuries.
METHODS: A retrospective multi-institutional study was performed at 13 Level 1 and Level 2 trauma centers from 2012 to 2021. Adult patients with major liver trauma (grade 3 and higher) requiring operative management were enrolled. Univariate and multivariate analyses were performed.
RESULTS: Three hundred seventy-two patients were included with 21.2% (n = 79/372) developing an IAA. No difference was found for age, gender, injury severity score, liver injury grade, and liver resections in patients between the groups (P > 0.05). Penetrating mechanism of injury (odds ratio (OR) 3.42, 95% confidence interval (CI) 1.54-7.57, P = 0.02), intraoperative massive transfusion protocol (OR 2.43, 95% CI 1.23-4.79, P = 0.01), biloma/bile leak (OR 2.14, 95% CI 1.01-4.53, P = 0.04), hospital length of stay (OR 1.04, 95% CI 1.02-1.06, P < 0.001), and additional intra-abdominal injuries (OR 2.27, 95% CI 1.09-4.72, P = 0.03) were independent risk factors for IAA. Intra-abdominal drains, damage control laparotomy, total units of packed red blood cells, number of days with an open abdomen, total abdominal surgeries, and blood loss during surgery were not found to be associated with a higher risk of IAA.
CONCLUSIONS: Patients with penetrating trauma, massive transfusion protocol activation, longer hospital length of stay, and injuries to other intra-abdominal organs were at higher risk for the development of an IAA following operative liver trauma. Results from this study could help to refine existing guidelines for managing complex operative traumatic liver injuries.
摘要：
背景：手术肝外伤的重要并发症之一是腹腔脓肿（IAA）。这项研究的目的是确定与严重手术肝外伤的手术患者术后IAA相关的危险因素。
方法：从2012年到2021年，在13个1级和2级创伤中心进行了一项回顾性多机构研究。招募了需要手术治疗的严重肝外伤（3级及以上）的成年患者。进行单变量和多变量分析。
结果：纳入了三百七十二名患者，其中21.2％（n=79/372）发展为IAA。年龄没有差异，性别,损伤严重程度评分,肝损伤分级,和肝切除患者组间比较(P>0.05)。损伤的穿透机制（优势比（OR）3.42，95％置信区间（CI）1.54-7.57，P=0.02），术中大量输血方案(OR2.43,95%CI1.23-4.79,P=0.01),胆汁瘤/胆漏（OR2.14，95％CI1.01-4.53，P=0.04），住院时间（OR1.04，95%CI1.02-1.06，P<0.001），和其他腹内损伤（OR2.27，95％CI1.09-4.72，P=0.03）是IAA的独立危险因素。腹内引流,损伤控制剖腹手术，红细胞的总单位,腹部开放的天数，全腹部手术,并且未发现手术过程中的失血与较高的IAA风险相关。
结论：穿透性创伤患者，大量输血方案激活,住院时间更长，手术肝损伤后，其他腹内器官损伤发生IAA的风险更高。这项研究的结果可以帮助完善现有的指南来管理复杂的手术创伤性肝损伤。
方法：从2012年到2021年，在13个1级和2级创伤中心进行了一项回顾性多机构研究。招募了需要手术治疗的严重肝外伤（3级及以上）的成年患者。进行单变量和多变量分析。
结果：纳入了三百七十二名患者，其中21.2％（n=79/372）发展为IAA。年龄没有差异，性别,损伤严重程度评分,肝损伤分级,和肝切除患者组间比较(P>0.05)。损伤的穿透机制（优势比（OR）3.42，95％置信区间（CI）1.54-7.57，P=0.02），术中大量输血方案(OR2.43,95%CI1.23-4.79,P=0.01),胆汁瘤/胆漏（OR2.14，95％CI1.01-4.53，P=0.04），住院时间（OR1.04，95%CI1.02-1.06，P<0.001），和其他腹内损伤（OR2.27，95％CI1.09-4.72，P=0.03）是IAA的独立危险因素。腹内引流,损伤控制剖腹手术，红细胞的总单位,腹部开放的天数，全腹部手术,并且未发现手术过程中的失血与较高的IAA风险相关。
结论：穿透性创伤患者，大量输血方案激活,住院时间更长，手术肝损伤后，其他腹内器官损伤发生IAA的风险更高。这项研究的结果可以帮助完善现有的指南来管理复杂的手术创伤性肝损伤。
