81.03 Hepatoportal Venous Trauma: Analysis of Incidence, Morbidity and Mortality

Posted on January 31, 2019

S. Maithel1, A. Grigorian1, N. Kabutey1, B. Sheehan1, S. Gambhir1, J. Nahmias1  1University Of California – Irvine,Surgery,Orange, CA, USA

Introduction:

Traumatic injuries to the superior mesenteric, portal and hepatic veins are rare with an incidence of roughly 0.1%. However, the mortality rates are high ranging from 45-52.7% for superior mesenteric vein (SMV), 50-70% for portal vein (PV), and 50-100% for hepatic vein (HV) injuries in small previous single center reports. We hypothesize that SMV injury is associated with lower risk of mortality compared to HV and PV injury in adult trauma patients.

Methods:

The Trauma Quality Improvement Program database (2010-2016) was queried for patients with injury to either the SMV, PV, or HV. A multivariable logistic regression model was used for analysis.

Results:

From 1,403,466 patients, 509 patients had SMV injury, 357 patients had PV injury and 255 patients had HV injury. Compared to patients with PV and HV injuries, patients with SMV injuries were older (39 years vs 29 years, p<0.01), had lower injury severity score (25 vs 26, p<0.01), and a lower percentage of severe (grade >3) abbreviated injury scale for abdomen (57.6% vs 72.3%, p<0.01). A higher percentage of SMV injuries were from blunt mechanism compared to portal and hepatic vein injury (60.3% vs 48.1%, p<0.01). Patients with a SMV injury had a longer length of stay (9 days vs 6 days, p=0.01), higher rates of concurrent bowel resection (38.1% vs 9.9%, p<0.01), and lower mortality (36% vs 47.9%, p<0.01) compared to patients with PV and HV injuries. However, after controlling for covariates, traumatic SMV injury increased risk of mortality (OR 2.37, CI=1.55-3.62, p<0.001) in adult trauma patients as did PV injury (OR 3.74, CI=2.29-6.12, p<0.001) and HV injury (OR 3.44, CI=1.95-6.07, p<0.001).

Conclusion:

Traumatic SMV injury is associated with a lower rate of mortality compared to injuries of the HV and PV. SMV injury greater than doubles the risk of mortality in adult trauma patients, whereas HV injury more than triples the risk and portal vein injury nearly quadruples the risk of mortality.