Outcomes following hepatic angioembolization for patients with traumatic liver injury.

Background: Management of traumatic liver injury includes observation, hemorrhage control laparotomy (HCL), and/or liver angioembolization (LAE). Although the literature supports LAE as an effective option, procedure-related complications are well described and not uncommon. The purpose of this study is to evaluate whether LAE is associated with worse outcomes in both patients undergoing HCL and patients managed expectantly.

Methods: This is a retrospective analysis of patients with grades III to V traumatic liver injury enrolled in the 2018 to 2020 Trauma Quality Improvement Program database. Two comparisons were performed: (1) HCL within 24 hours of admission with and without LAE, and (2) no HCL within 24 hours of admission with and without LAE. Propensity score matching was used to account for differences in patient acuity, and univariate analysis was performed to compare groups.

Results: Both groups were well balanced after matching. Among patients with initial HCL, concomitant LAE did not affect mortality, length of stay, or complications. Patients with LAE underwent more percutaneous liver drainage procedures (7.8% vs. 3.3%, p=0.016). In the second comparison, LAE was associated with a statistically significant increase in hospital length of stay (17.6 days vs. 14.2 days, p<0.001) and more percutaneous liver drainage procedures (4.3% vs. 0.8%, p=0.002) but less open liver repairs (3.5% vs. 8.3%, p=0.004). For both cohorts, patients undergoing LAE had significantly higher 4-hour transfusion volumes.

Conclusion: LAE following traumatic liver injury is associated with more percutaneous liver drainage procedures. It is associated with increased hospital length of stay when compared with patients who are managed expectantly, but does not significantly affect mortality or hospital complications. Although the literature reports a high rate of liver-related complications, we found a relatively lower rate of liver-related interventions, particularly in the non-operative group.

Level of evidence: III.