A. A. Smith1, H. Mejia Morales1, R. Fabian1, J. Friedman1, C. Guidry1, P. McGrew1, R. Schroll1, C. McGinness1, J. Duchesne1 1Tulane University School Of Medicine,Surgery,New Orleans, LA, USA
Introduction: The management of patients with liver trauma represents a wide range of clinical practices. Despite this evolution, there are very few studies that critically evaluate current practices of trauma surgeons for the management of liver trauma. Historical studies have recommended against the use of drains, but there has not been a modern investigation of this issue. The objective of this study was to compare drain use following operative management of liver trauma.
Methods: A retrospective chart review of all adult patients presenting as trauma patients to a Level I trauma center from 2012-2018 was performed. The primary endpoint evaluated was post-operative intra-abdominal abscess (IAA). Univariate and multivariate analyses were performed.
Results: 144 patients with operative management of liver traumawere included in the study. Penetrating trauma was the most common mechanism. Drains were utilized in 29.9% of post-operative patients. IAA were higher in the drain group (27.9% vs 5.9%, p=0.0006). Drains were used in patients receiving more units of PRBCs (19.2+3.6 vs. 12.9+1.4, p=0.0492). Drain use was found to be an independent risk factor for post-operative intra-abdominal abscess on multivariate analysis (OR 6.5, 95% CI 1.9-22.6, p=0.003).
Conclusion: Results from this study support previous conclusions that drain use for the management of operative liver trauma is associated with an increased risk of IAA formation. Future studies should focus on the development of specific guidelines for the use of drains, especially with the evolving management of liver trauma.
