Outcomes of angioembolization in penetrating hepatic trauma: Equivalent survival, longer hospitalization.

Abstract

BACKGROUND: Angioembolization has become an important adjunct in the management of hepatic trauma, but its role in penetrating injuries remains uncertain. We aimed to evaluate outcomes between angioembolization and surgery in the acute management of penetrating liver trauma using a national trauma database. METHODS: A retrospective cohort study was conducted using the Trauma Quality Improvement Program (2016-2019). Patients with penetrating liver trauma undergoing angioembolization or surgery were included. Propensity score matching and inverse probability of treatment weighting were applied to adjust for baseline differences. Primary outcomes were mortality, hospital length of stay, intensive care unit length of stay, and ventilator days. A subset analysis examined predictors for adjunctive angioembolization after primary surgery. RESULTS: Among 8,890 eligible patients, 315 (16.9%) underwent angioembolization, 1,485 (79.5%) underwent surgery, and 69 (3.7%) underwent both procedures. After propensity score matching (n = 586), mortality did not differ significantly between angioembolization and surgery (2.0% vs 4.8%, P = .069). However, angioembolization was associated with longer hospital length of stay (17.3 vs 11.7 days, P < .001), intensive care unit length of stay (8.8 vs 4.3 days, P < .001), and ventilator days (5.0 vs 2.2 days, P < .001). Inverse probability of treatment weighting analysis confirmed these findings. In surgical patients (n = 1,541), independent predictors of requiring adjunctive angioembolization were lower systolic blood pressure at admission (odds ratio, 0.982), higher Abdominal Abbreviated Injury Scale (odds ratio, 1.451), and greater transfusion requirements (odds ratio, 1.006). CONCLUSION: In penetrating liver trauma, angioembolization provides survival outcomes comparable to surgery but is associated with longer intensive care unit and hospital stays. Early identification of high-risk patients may optimize integration of surgical and interventional strategies.