Hybrid treatment combining emergency surgery and intraoperative interventional radiology for severe trauma.
OBJECTIVE
To evaluate the efficacy of hybrid treatment combining emergency surgery and intraoperative interventional radiology (IVR) for severe trauma.


METHODS
The records of 63 severely injured patients who underwent concurrent emergency surgery and IVR at our emergency centre from 1999 through 2013 were retrospectively reviewed. Mobile digital subtraction angiography device was used in the operating room when performing IVR. Patients undergoing hybrid treatment combining intraoperative IVR and emergency surgery (intraoperative IVR group) were compared with those undergoing IVR in the angiography suite before or after emergency surgery (control group).


RESULTS
Thirteen patients underwent hybrid treatment (intraoperative IVR group). Of these 13 patients, 7 underwent treatment for abdominal organ injuries, and 6 for multiregional injuries. Emergency operations were laparotomy (n=12), thoracotomy (n=1), craniotomy (n=1), and haemostasis of the lower extremities (n=1). Five patients underwent damage control surgery. IVR included transarterial embolisation (n=12), endovascular stent or stent-graft placement (n=2), and embolisation of a portal vein by laparotomy (n=2). The mean ISS was 40. The actual overall survival rate was 85%, and the probability of survival (Ps) was 62%. The control group included 45 patients. Five patients who met exclusion criteria were not included in the control group. Age, ISS, RTS, Ps, pH and base excess on arrival, and blood transfusion volume during operation and IVR did not differ significantly between the groups. Total time during operation and IVR was significantly shorter in the intraoperative IVR group than in the control group (229 [SD 72]min vs. 355 [SD 169]min; p=0.007). The mortality were 15 (95% CI 2-45) % in the intraoperative IVR group vs. 36 (95% CI 22-51) % in the control group.


CONCLUSIONS
Hybrid treatment combining emergency surgery and intraoperative IVR can be a novel treatment strategy for severe trauma, and it will improve patient outcomes due to reduction of the time for resuscitation.
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan. Electronic address: kataoka760@yahoo.co.jp.
Yuichi
Y
Kataoka
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan. Electronic address: jpminet@aol.com.
Hiroaki
H
Minehara
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan. Electronic address: kashimifumie@gmail.com.
Fumie
F
Kashimi
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan. Electronic address: tasuku12hanajima5@gmail.com.
Tasuku
T
Hanajima
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan. Electronic address: t-yamaya@kitasato-u.ac.jp.
Tatsuhiro
T
Yamaya
Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Japan. Electronic address: h2nishimaki@gmail.com.
Hiroshi
H
Nishimaki
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan. Electronic address: docya119@gmail.com.
Yasushi
Y
Asari
D015901:Angiography, Digital Subtraction; D001803:Blood Transfusion; D003399:Craniotomy; D004621:Embolization, Therapeutic / Q000379:methods*; D006487:Hemostasis; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007813:Laparotomy; D015641:Radiography, Interventional / Q000379:methods; D012189:Retrospective Studies; D013908:Thoracotomy; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000628:therapy
Emergency surgery; IVR; Intraoperative; Trauma; hybrid