O. A. Vazquez1, M. Gomez3, A. A. Fokin2, M. Crawford2, J. Wycech2,3, A. Tymchak1,2,3, I. Puente1,2,3,4 1Florida Atlantic University,College Of Medicine,Boca Raton, FL, USA 2Delray Medical Center,Trauma Services,Delray Beach, FL, USA 3Broward Health Medical Center,Trauma Services,Fort Lauderdale, FL, USA 4Florida International University,College Of Medicine,Miami, FL, USA
Introduction:
Nonoperative management (NOM) of blunt liver injuries (BLI) has become the standard of care in hemodynamically stable patients without indications for laparotomy. However, controversy remains regarding the contraindications for NOM in the geriatric population. The goal of this study was to assess the efficacy of NOM in geriatric as compared to non-geriatric patients with liver injuries.
Methods:
This IRB approved retrospective cohort study included 108 adult patients with BLI who were admitted to a level I trauma center from 2012 to 2017. Of these 108 patients, 19.4% (n=21) were ≥65 years old (Geriatric Group) and 80.6% (n=87) were <65 (Non-Geriatric Group). Analyzed variables included injury severity score (ISS), liver organ injury scale (LOIS) grade, Glasgow Coma Scale (GCS), incidences of packed red blood cells transfused within 24 hours (PRBC24), angiography, embolization, repeat abdominal computed tomography (CT), hemoperitoneum, anticoagulation or antiplatelet therapy prior to trauma, spine co-injuries, management approach, intensive care unit length of stay (ICULOS), hospital LOS (HLOS), and mortality.
Results:
Geriatric Group was significantly older (76.8 vs 36.9 years, p<0.001). The two groups showed no statistical difference between mean ISS (19.9 vs 22.1), LOIS grade (2.1 vs 2.4), GCS (13.6 vs 11.8), rates of PRBC24 (42.9% vs 34.5%), angiography (19.0% vs 23.0%), embolization (4.8% vs 10.3%), repeat CT (42.9% vs 23.0%) and hemoperitoneum (47.6% vs 47.1%), with all p>0.06.
Geriatric Group had a higher rate of pre-injury anticoagulation therapy (38.1% vs 6.9%, p<0.001), and of spinal co-injuries (57.1% vs 29.5%, p=0.02) than Non-Geriatrics.
NOM was attempted in 75.0% of Geriatric versus 71.3% of Non-Geriatric patients (p=0.7). Failure of NOM rate between the two Groups was also not significantly different (13.3% vs 9.7%, p=0.7). In the Geriatric Group 2 out of the 2 and in the Non-Geriatric Group 3 out of the 6 failed NOM were due to the liver injury, with the rest in the Non-Geriatric Group due to other abdominal organ injury.
Geriatric and Non-Geriatric Groups did not have statistically different ICULOS (10.9 vs 7.2 days), HLOS (12.6 vs 10.3 days), and mortality (19.0% vs 10.3%), with all p>0.2. Three out of 4 Geriatric and 5 out of 9 Non-Geriatric patients died due to their abdominal trauma, including BLI, whereas the remainder of deaths were due to pulmonary insufficiency or TBI.
Conclusion:
Age was not a contraindication for non-operative management of abdominal trauma with liver injuries, as all outcomes in Geriatric and Non-Geriatric patients were comparable. Non-operative management should still be attempted in the Geriatric population despite their advanced age.