Comparison of Timing of Definitive Pelvic Fixation in Pelvic Fracture Treated with Preperitoneal Pelvic Packing or Angioembolization.

Abstract

Preperitoneal pelvic packing (PPP) and angioembolization (AE) are current hemostatic techniques in patients with bleeding pelvic fracture. Concerns exist that PPP may delay definitive internal fixation of pelvic fractures. This study aimed to determine whether PPP results in delayed internal fixation compared with AE. A retrospective cohort study was conducted using the TQIP database from 2017 to 2021. Adults with isolated pelvic fractures requiring transfusion within 24 hours were included. Patients underwent internal fixation and received either PPP (90) or AE only (253). Inverse probability of treatment weighting was used to adjust for confounding variables. The primary outcome was time from admission to internal fixation; secondary outcomes included in-hospital mortality and hospital resource use. Time to definitive fixation was not significantly different between groups (PPP median 51.4 hours vs AE median 37.5 hours; p = 0.071). In-hospital mortality was higher in the PPP group (4.4% vs 0.6%; p = 0.009). The PPP group had longer ICU and hospital stays, extended mechanical ventilation duration, and higher rates of acute kidney injury and severe sepsis. No significant difference in transfusion volume within 4 hours was observed between the groups. PPP does not significantly delay definitive internal fixation. However, the implementation of PPP for patients with pelvic fractures may be associated with increased complications and hospital resource use compared with AE alone as a hemostatic measure.