TY - JOUR
T1 - Nonoperative management of blunt abdominal solid organ injury
T2 - Are we paying enough attention to patients on preinjury anticoagulation?
AU - Reina, Raul
AU - Anand, Tanya
AU - Bhogadi, Sai K.
AU - Nelson, Adam
AU - Hosseinpour, Hamidreza
AU - Ditillo, Michael
AU - El-Qawaqzeh, Khaled
AU - Castanon, Lourdes
AU - Stewart, Collin
AU - Joseph, Bellal
N1 - Publisher Copyright:
© 2022
PY - 2022/11
Y1 - 2022/11
N2 - Background: This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM. Methods: A 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed. Results: A matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10–24]vs.17[12–26]days,p = 0.04) and ICU LOS (11[6–17]vs.11[7–18]days,p = 0.01). Conclusion: Among nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants. Level of evidence: Level III. Study type: Therapeutic/care management.
AB - Background: This study aims to assess the impact of pre-injury anticoagulant use on outcomes of isolated blunt abdominal SOI patients who underwent NOM. Methods: A 1-year(2017) analysis of the ACS-TQIP. We included all ≥18yrs trauma patients with isolated blunt abdominal-SOI who underwent NOM. Patients were stratified into two groups based on their history of pre-injury anticoagulant use. Propensity score matching was performed. Results: A matched cohort of 2709 patients (AC, 903; No-AC,1806) was analyzed. Compared to the No-AC group, the AC group had higher rates of failure of NOM(2.6% vs. 4.5%, p = 0.03), cardiac arrest (1.2%vs. 3.1%, p = 0.02), acute kidney injury (2.4% vs. 4.2%, p < 0.01), myocardial infarction (0.6% vs. 1.4%,p = 0.03), and mortality (5.1%vs. 7.6%,p = 0.01), and longer hospital LOS (17[10–24]vs.17[12–26]days,p = 0.04) and ICU LOS (11[6–17]vs.11[7–18]days,p = 0.01). Conclusion: Among nonoperatively managed blunt abdominal SOI patients, preinjury use of anticoagulants negatively impacts outcomes. Extra surveillance is required while managing patients with blunt abdominal SOI on pre-injury anticoagulants. Level of evidence: Level III. Study type: Therapeutic/care management.
KW - Adults
KW - Blunt abdominal injury
KW - Preinjury anticoagulation
KW - Solid organ injury
KW - Trauma
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U2 - 10.1016/j.amjsurg.2022.06.019
DO - 10.1016/j.amjsurg.2022.06.019
M3 - Article
C2 - 35778232
AN - SCOPUS:85133385982
SN - 0002-9610
VL - 224
SP - 1308
EP - 1313
JO - American journal of surgery
JF - American journal of surgery
IS - 5
ER -