Factors that influence the operative mortality after blunt hepatic injuries.
OBJECTIVE
To analyse causes of death and possible factors that influenced the operative mortality in patients with blunt hepatic injuries.


METHODS
Retrospective case study.


METHODS
Medical center, Taiwan.


METHODS
109 adult patients with blunt hepatic injuries were treated surgically over the four year period from September 1987 to August 1991.


METHODS
Mortality.


RESULTS
36 patients (33%) had hepatorrhaphy or no repair, complex repairs were done for 73 patients (67%) and the overall mortality was 22% (24/109). Of those deaths, however, 4 were not liver-related, giving us a liver-related mortality of 19% (20/105). Fourteen of the liver-related deaths occurred within 24 hours of injury of hemorrhagic shock or coagulopathy. Six occurred after 24 hours of sepsis and multiple system organ failure. Multivariate analysis showed that higher initial aspartate aminotransferase (AST) and Injury Severity Score as well as increasing operative blood loss resulted in a worsening prognosis.


CONCLUSIONS
The initial AST activity and Injury Severity Score as well as the total operative blood loss were the significant factors that influenced the operative mortality after blunt hepatic injuries in our study. Prompt, expeditious, and appropriate surgical management to control operative loss is the only way for the surgeon to reduce the mortality of blunt hepatic injuries.
Chen
R J
RJ
Division of Trauma and Emergency Surgery, Chang Gung Medical College, Chang Gung Memorial Hospital Taipei, Taiwan, ROC.
Fang
J F
JF
Lin
B C
BC
Wang
Y D
YD
Chen
M F
MF
D000293:Adolescent; D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D002423:Cause of Death; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000601:surgery
D001219:Aspartate Aminotransferases