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World J Surg. 2018 Dec;42(12):3947-3953. doi: 10.1007/s00268-018-4739-y.

Early Surgery in Prone Position for Associated Injuries in Patients Undergoing Non-operative Management for Splenic and Liver Injuries.

Author information

1
Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
2
Department of Orthopedic Surgery, Bern University Hospital, Bern, Switzerland.
3
Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland. beat.schnuriger@gmail.ch.
4
Division of Acute Care Surgery, Department of Visceral and Transplant Surgery, Bern University Hospital, Bern, 3010, Switzerland. beat.schnuriger@gmail.ch.

Abstract

BACKGROUND:

In patients undergoing non-operative management (NOM) of blunt splenic and/or liver injuries, no data exist on the safety of same-admission surgery in prone position for concomitant injuries.

METHODS:

Retrospective study including adult trauma patients with blunt splenic/liver injuries and attempted NOM from 01/2009 to 06/2015 was conducted. Patient and injury characteristics as well as outcomes [failed (f)NOM, mortality] of patients with/without surgery in prone position were compared ('prone' vs. 'non-prone' group).

RESULTS:

A total of 244 patients with blunt splenic/liver injury and attempted NOM were included. Forty patients (16.4%) underwent surgery in prone position on median post-injury day 2.0 [interquartile range (IQR) 3.0]. Surgery in prone position was mostly performed for associated spinal or pelvic injuries. The ISS was significantly higher, and the proportion of patients with high-grade injuries (OIS ≥ 3) was significantly less frequent in the 'prone' group (30.0 ± 14.5 vs. 23.9 ± 13.2, p = 0.009 and 27.5 vs. 53.9%, p = 0.002). In-hospital mortality as well as NOM failure rates were not significantly different between the 'prone' and 'non-prone' group (2.5 vs. 2.9%, p = 1.000; 0.0 vs. 4.4%, p = 0.362). Eleven patients with high-grade injuries were operated in prone position at median day 3 (IQR 3.0). None of these patients failed NOM. However, one patient with a grade IV splenic injury required immediate splenectomy after being operated in right-sided position on the day of admission.

CONCLUSION:

In this single-center analysis, surgery in prone position was performed in a substantial number of patients with splenic/liver injuries without increasing the fNOM rate. However, caution should be used in patients with grade IV/V splenic injuries.

PMID:
30030577
DOI:
10.1007/s00268-018-4739-y
[Indexed for MEDLINE]

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