Factors that influence the operative mortality after blunt hepatic injuries

Objective: To analyse causes of death and possible factors that influenced the operative mortality in patients with blunt hepatic injuries. Design: Retrospective case study. Setting: Medical center, Taiwan. Patients: 109 adult patients with blunt hepatic injuries were treated surgically over the four year period from September 1987 to August 1991. Main outcome measure: Mortality. Results: 36 patients (33%) had hepatorrhaphy or no repair, complex repairs were done for 73 patients (67%) and the overall mortality was 22% (24/109). Of those deaths, however, 4 were not liver-related, giving us a liver-related mortality of 19% (20/105). Fourteen of the liver-related deaths occurred within 24 hours of injury of hemorrhagic shock or coagulopathy. Six occurred after 24 hours of sepsis and multiple system organ failure. Multivariate analysis showed that higher initial aspartate aminotransferase (AST) and Injury Severity Score as well as increasing operative blood loss resulted in a worsening prognosis. Conclusion: The initial AST activity and Injury Severity Score as well as the total operative blood loss were the significant factors that influenced the operative mortality after blunt hepatic injuries in our study. Prompt, expeditious, and appropriate surgical management to control operative loss is the only way for the surgeon to reduce the mortality of blunt hepatic injuries.