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High incidence of surgical site infection may be related to suboptimal case selection for non-selective arterial embolization during resuscitation of patients with pelvic fractures: a retrospective study.
- Source :
-
BMC musculoskeletal disorders [BMC Musculoskelet Disord] 2020 May 30; Vol. 21 (1), pp. 335. Date of Electronic Publication: 2020 May 30. - Publication Year :
- 2020
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Abstract
- Background: In most institutions, arterial embolization (AE) remains a standard procedure to achieve hemostasis during the resuscitation of patients with pelvic fractures. However, the actual benefits of AE are controversial. In this study, we aimed to explore AE-related outcomes following resuscitation at our center and to assess the predictive value of contrast extravasation (CE) during computed tomography (CT) for patients with hemodynamically unstable closed pelvic fractures.<br />Methods: We retrospectively reviewed data from patients who were treated for closed pelvic fractures at a single center between 2014 and 2017. Data regarding the AE and clinical parameters were analyzed to determine whether poor outcomes could be predicted.<br />Results: During the study period, 545 patients were treated for closed pelvic fractures, including 131 patients who underwent angiography and 129 patients who underwent AE. Nonselective bilateral internal iliac artery embolization (nBIIAE) was the major AE strategy (74%). Relative to the non-AE group, the AE group had higher values for injury severity score, shock at hospital arrival, and unstable fracture patterns. The AE group was also more likely to require osteosynthesis and develop surgical site infections (SSIs). Fourteen patients (10.9%) experienced late complications following the AE intervention, including 3 men who had impotence at the 12-month follow-up visit and 11 patients who developed SSIs after undergoing AE and osteosynthesis (incidence of SSI: 11/75 patients, 14.7%). Nine of the 11 patients who developed SSI after AE had undergone nBIIAE. The positive predictive value of CE during CT was 29.6%, with a negative predictive value of 91.3%. Relative to patients with identifiable CE, patients without identifiable CE during CT had a higher mortality rate (30.0% vs. 11.0%, pā=ā0.03).<br />Conclusion: Performing AE for pelvic fracture-related hemorrhage may not be best practice for patients with no CE detected during CT or for unstable patients who do not respond to resuscitation after exclusion of other sources of hemorrhage. Given the high incidence of SSI following nBIIAE, this procedure should be selected with care. Given their high mortality rate, patients without CE during imaging might be considered for other hemostasis procedures, such as preperitoneal pelvic packing.
- Subjects :
- Adolescent
Adult
Aged
Angiography
Embolization, Therapeutic methods
Female
Fractures, Bone diagnostic imaging
Hemorrhage diagnostic imaging
Hemorrhage mortality
Humans
Incidence
Injury Severity Score
Male
Middle Aged
Retrospective Studies
Young Adult
Fractures, Bone therapy
Hemorrhage therapy
Pelvic Bones injuries
Surgical Wound Infection epidemiology
Tomography, X-Ray Computed
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2474
- Volume :
- 21
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC musculoskeletal disorders
- Publication Type :
- Academic Journal
- Accession number :
- 32473630
- Full Text :
- https://doi.org/10.1186/s12891-020-03372-5