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Nonoperative Management (NOM) of most liver injuries impairs the mastery of intraoperative hemostasis.
Am J Surg 2019AJ

Abstract

BACKGROUND

Nonoperative management (NOM) of most liver injury (LI) compromises teaching of technical skills required for intraoperative LI hemostasis. This study assesses this void.

METHODS

The records of patients (pts) admitted for LI during two years (1/1/16-12/31/17) were compared to pts treated during two-year intervals for the last six decades. Treatment included NOM, operation only (OR/only), suture (Sut), tractotomy (Tra), dearterialization (HAL), and resection (Res).

RESULTS

During 2016/2017, 41 pts had penetrating (23) or blunt (18) LI. Treatment for penetrating LI was NOM (4), OR/only (12), and hemostasis (7) with Sut (3), HAL (1), Tra (1), and Res (2). Treatment for blunt LI was NOM (16) and OR/only (2). 14 residents performed an average of 0.5 procedures. During six decades, LI requiring hemostasis was 121, 114, 30, 48, 17, and 7 per decade. Concomitantly, the percent having NOM or OR/only was 46%, 47%, 62%, 59%, 72%, and 83%.

CONCLUSION

NOM precludes adequate training for hemostasis of LI. Technical proficiency for LI hemostasis requires training in Advanced Trauma Operative Management (ATOM), Advanced Surgical Skills for Exposure in Trauma (ASSET), and rotation through a liver transplant or hepatobiliary service.

Authors+Show Affiliations

Wayne State University School of Medicine, Michael & Marian Ilitch Department of Surgery, Detroit, MI, USA.Ascension St. John Hospital, Department of Surgery, Detroit, MI, USA.Wayne State University School of Medicine, Michael & Marian Ilitch Department of Surgery, Detroit, MI, USA.Wayne State University School of Medicine, Michael & Marian Ilitch Department of Surgery, Detroit, MI, USA. Electronic address: clucas@med.wayne.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31594556

Citation

Lee, Solhee, et al. "Nonoperative Management (NOM) of Most Liver Injuries Impairs the Mastery of Intraoperative Hemostasis." American Journal of Surgery, 2019.
Lee S, Buck JR, Ledgerwood AM, et al. Nonoperative Management (NOM) of most liver injuries impairs the mastery of intraoperative hemostasis. Am J Surg. 2019.
Lee, S., Buck, J. R., Ledgerwood, A. M., & Lucas, C. E. (2019). Nonoperative Management (NOM) of most liver injuries impairs the mastery of intraoperative hemostasis. American Journal of Surgery, doi:10.1016/j.amjsurg.2019.09.038.
Lee S, et al. Nonoperative Management (NOM) of Most Liver Injuries Impairs the Mastery of Intraoperative Hemostasis. Am J Surg. 2019 Sep 30; PubMed PMID: 31594556.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nonoperative Management (NOM) of most liver injuries impairs the mastery of intraoperative hemostasis. AU - Lee,Solhee, AU - Buck,Joseph R, AU - Ledgerwood,Anna M, AU - Lucas,Charles E, Y1 - 2019/09/30/ PY - 2019/06/21/received PY - 2019/09/25/revised PY - 2019/09/27/accepted PY - 2019/10/10/entrez PY - 2019/10/9/pubmed PY - 2019/10/9/medline KW - NOM of liver injury KW - Resident education KW - Teaching hemostatic techniques JF - American journal of surgery JO - Am. J. Surg. N2 - BACKGROUND: Nonoperative management (NOM) of most liver injury (LI) compromises teaching of technical skills required for intraoperative LI hemostasis. This study assesses this void. METHODS: The records of patients (pts) admitted for LI during two years (1/1/16-12/31/17) were compared to pts treated during two-year intervals for the last six decades. Treatment included NOM, operation only (OR/only), suture (Sut), tractotomy (Tra), dearterialization (HAL), and resection (Res). RESULTS: During 2016/2017, 41 pts had penetrating (23) or blunt (18) LI. Treatment for penetrating LI was NOM (4), OR/only (12), and hemostasis (7) with Sut (3), HAL (1), Tra (1), and Res (2). Treatment for blunt LI was NOM (16) and OR/only (2). 14 residents performed an average of 0.5 procedures. During six decades, LI requiring hemostasis was 121, 114, 30, 48, 17, and 7 per decade. Concomitantly, the percent having NOM or OR/only was 46%, 47%, 62%, 59%, 72%, and 83%. CONCLUSION: NOM precludes adequate training for hemostasis of LI. Technical proficiency for LI hemostasis requires training in Advanced Trauma Operative Management (ATOM), Advanced Surgical Skills for Exposure in Trauma (ASSET), and rotation through a liver transplant or hepatobiliary service. SN - 1879-1883 UR - https://www.unboundmedicine.com/medline/citation/31594556/Nonoperative_Management_(NOM)_of_most_liver_injuries_impairs_the_mastery_of_intraoperative_hemostasis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9610(19)30860-8 DB - PRIME DP - Unbound Medicine ER -