Hybrid treatment combining emergency surgery and intraoperative interventional radiology for severe trauma |
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| Institution: | 1. Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Japan;2. Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Japan;1. Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;3. The Leonard Davis Institute, Wharton School of Business at the University of Pennsylvania, Philadelphia, PA, United States;4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;5. Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;6. Department of Emergency Medicine, Jefferson University School of Philadelphia Medicine, PA, United States;1. Department of Trauma Research, Medical Center of Plano, 3901 West 15th Street, Plano, TX 75075, United States;2. Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO 80113, United States;3. Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO 80228, United States;4. Trauma Services Department, Medical Center of Plano, 3901 W. 15th St, Plano, TX 75075, United States;5. Trauma Services Department, St. Anthony Hospital, 11600 West 2nd Place, Lakewood, CO 80228, United States;7. Trauma Services Department, Swedish Medical Center, 499 E. Hampden Ave, Englewood, CO 80113, United States;6. Trauma Services Department, Intermountain Neurosurgery, 11700 W. 2nd Place, Lakewood, CO 80228, United States;8. Trauma Services Department, Rocky Vista University, 8401 S. Chambers Rd, Parker, CO 80134, United States;1. Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Foundation, United States;2. Bureau of Sciences Services, Wisconsin Department of Natural Resources, United States;3. National Farm Medicine Center, Marshfield Clinic Research Foundation, United States;1. Department of Surgery, Kern Medical Center, USA;2. Department of Radiology, Kern Medical Center, USA;1. Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA;2. Emergency Medical Services Agency, Los Angeles County Department of Health Services, Santa Fe Springs, CA, USA |
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| Abstract: | ObjectTo evaluate the efficacy of hybrid treatment combining emergency surgery and intraoperative interventional radiology (IVR) for severe trauma.Patients and methodsThe 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).ResultsThirteen 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.ConclusionHybrid 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. |
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| Keywords: | Trauma hybrid Intraoperative IVR Emergency surgery |
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