title: The effect of cirrhosis on the risk for failure of nonoperative management of blunt liver injuries.
abstract: BACKGROUND
  The purpose of this study was to delineate the association between cirrhosis and failure of nonoperative management (F-NOM) after blunt liver trauma.
  
  
  METHODS
  We carried out a review of the National Trauma Databank from 2007 to 2011 including patients ≥ 16 years old admitted after a blunt injury. Propensity score was used to match each cirrhotic to 3 noncirrhotic patients. Primary outcome was F-NOM (liver procedure >2 hours after admission and/or operative intervention directed at the liver after angiography).
  
  
  RESULTS
  A total of 57 cirrhotic patients who met inclusion criteria were matched with 171 noncirrhotic patients. Splenic injury was present in 41% (35% vs 43%; P = .31) and 28% had a high-grade liver injury III/VI/V (26% vs 29%; P = .73). The majority of patients in both groups were selected for a trial of NOM (77% vs 85%; P = .15). There was no difference in the rate of F-NOM between the 2 groups (14% vs 14%; P = 1.00), even for high-grade injuries (13% vs 20%; P = .72). Cirrhotic patients had a greater overall mortality (28% vs 7%; P < .01), especially if they required a laparotomy (58% vs 17%; P < .01) or if they failed NOM (50% vs 4%; P < .01).
  
  
  CONCLUSIONS
  Cirrhosis has no effect on the selection of patients with blunt liver injuries for a trial of nonoperative management and does not seem to be associated with a greater risk for failure of nonoperative management within the constraints of our study. Nonoperative management in this population is highly successful and failure is rarely related directly to the liver injury itself. Failure of non-operative management increases the already high mortality risk in this population.
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA.
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
authors.affiliation: Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, MA. Electronic address: asalim1@partners.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017211:Treatment Failure; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*