Nonoperative management of blunt abdominal solid organ injury: Are we paying enough attention to patients on preinjury anticoagulation?

Raul Reina, Tanya Anand, Sai K. Bhogadi, Adam Nelson, Hamidreza Hosseinpour, Michael Ditillo, Khaled El-Qawaqzeh, Lourdes Castanon, Collin Stewart, Bellal Joseph

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1308-1313
Number of pages6
JournalAmerican journal of surgery
Volume224
Issue number5
DOIs
StatePublished - Nov 2022

Keywords

  • Adults
  • Blunt abdominal injury
  • Preinjury anticoagulation
  • Solid organ injury
  • Trauma

ASJC Scopus subject areas

  • Surgery

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