Influence of postoperative hepatic angiography on mortality after laparotomy in Grade IV/V hepatic injuries

Shokei Matsumoto, Emily Cantrell, Kyoungwon Jung, Alan Smith, Raul Coimbra

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


BACKGROUND Mortality rate for severe liver injuries remains high. As an adjunct to surgery, postoperative hepatic angiography (PHA) may have a positive impact on outcomes. This study sought to compare outcomes following surgical management of severe liver injuries with and without PHA using propensity score matching analysis. METHODS Data from the National Trauma Data Bank from 2007 to 2014 were analyzed. The study population consisted of patients older than 18 years, sustaining severe liver injuries (i.e., American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS) Grade IV or V) who underwent surgery. Patients were divided into two groups. The PHA group consisted of those undergoing surgery followed by PHA. In the surgery-only group, no angiography was performed. To determine the impact of PHA on outcomes, propensity score matching analysis (1:3) was used. RESULTS A total of 3,871 patients met inclusion criteria. Of those, 205 (5.3%) patients underwent PHA. Prior to matching, patients in the PHA group had higher severity, but overall in-hospital mortality was found to be similar between the two groups. After 1:3 propensity-score matching, 196 patients in the PHA group were matched with 588 in the surgery-only group with well-balanced baseline characteristics. The in-hospital mortality was significantly lower in the PHA group compared with the surgery-only group (24.5% vs. 35.9%; odds ratio, 0.58; 95% confidence interval, 0.40-0.84). However, hospital length of stay was longer (16.0 [7.0-29.8] vs. 11 [1.0-25.0] days, p = 0.001), and the incidence of deep and organ/space surgical site infection (3.6% vs. 1.2%, 8.2% vs. 3.5%, respectively) was higher in the PHA group. CONCLUSION The use of PHA was associated with decreased mortality rates. A multimodality approach using both surgical intervention followed by PHA appears to identify patients that may benefit from arterial embolization, leading to decreased mortality of severe liver injuries. LEVEL OF EVIDENCE Therapeutic study, level IV.

Original languageEnglish (US)
Pages (from-to)290-297
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Issue number2
StatePublished - Aug 1 2018
Externally publishedYes


  • complications
  • Liver injury
  • postoperative angiography

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


Dive into the research topics of 'Influence of postoperative hepatic angiography on mortality after laparotomy in Grade IV/V hepatic injuries'. Together they form a unique fingerprint.

Cite this