T. Tan1, J. Sabat1, P. Hsu1, N. Samra2, Q. Chu2 1University Of Arizona,Tucson, AZ, USA 2Louisiana State University Health Sciences Center,New Orleans, LA, USA
Introduction: Traumatic superior mesenteric vein (SMV) injury is rare, and the ideal treatment is controversial. We compared the outcomes of ligation versus repair of SMV injury using the National Trauma Database (NTDB).
Methods: All adult patients who suffered from traumatic SMV injury were identified from NTDB (2002-2014) by International Classification of Diseases (ICD), Ninth Revision Diagnosis codes. Patients were stratified on the basis of treatment modality into observation, ligation, and surgical repair using ICD procedure codes. Outcomes including hospital mortality, bowel resection, hospital and intensive care unit (ICU) length of stay (LOS) between ligation and surgical repair were compared by two-sample t-test or X2 test as appropriate.
Results: Among 952 patients with SMV injury, 332 patients (34.9%) were observed, 192 patients (20.2%) had ligation and 428 (50%) underwent surgical repair. More than 92% of injury was from penetrating trauma and overall hospital mortality was 32%. Age, gender, injury severity score (ISS), and Glasgow Coma Scale (GCS) were similar between groups that underwent ligation and surgical repair. Although the mortality rate (29.4% vs. 36.5%, p=.20) and bowel resection (4% vs. 3%, p=.12) were similar, patients who underwent repair had significantly longer hospital LOS (19.4±24.8 vs.15.2±24.4 days, p<.001) and ICU LOS (13±17.1 vs. 9.3±11.8 days, p=.02) compared to ligation. In multivariable analysis, although mortality and rate of bowel resection were similar, SMV repair was associated with significantly longer hospital LOS (RR 1.5, 95% CI 1.2,1.9 p<.01) and ICU LOS (RR 1.4, 95% CI 1.1,1.8, p<.01) compared to ligation.
Conclusion: In patients with traumatic SMV injury, surgical repair does not appear to confer a significant advantage over ligation and is associated with significantly longer hospital and intensive care unit length of stay. Ligation is an acceptable option in traumatic SMV injury, especially in critically ill patients.