@article{ref1,
title="Early surgery in prone position for associated injuries in patients undergoing non-operative management for splenic and liver injuries",
journal="World journal of surgery",
year="2018",
author="Markert, Kathrin and Haltmeier, Tobias and Khatsilouskaya, Tatsiana and Keel, Marius J. and Candinas, Daniel and Schnüriger, Beat",
volume="42",
number="12",
pages="3947-3953",
abstract="BACKGROUND: In patients undergoing non-operative management (NOM) of blunt splenic and/or liver injuries, no data exist on the safety of same-admission surgery in prone position for concomitant injuries. <br><br>METHODS: Retrospective study including adult trauma patients with blunt splenic/liver injuries and attempted NOM from 01/2009 to 06/2015 was conducted. Patient and injury characteristics as well as outcomes [failed (f)NOM, mortality] of patients with/without surgery in prone position were compared ('prone' vs. 'non-prone' group). <br><br>RESULTS: A total of 244 patients with blunt splenic/liver injury and attempted NOM were included. Forty patients (16.4%) underwent surgery in prone position on median post-injury day 2.0 [interquartile range (IQR) 3.0]. Surgery in prone position was mostly performed for associated spinal or pelvic injuries. The ISS was significantly higher, and the proportion of patients with high-grade injuries (OIS ≥ 3) was significantly less frequent in the 'prone' group (30.0 ± 14.5 vs. 23.9 ± 13.2, p = 0.009 and 27.5 vs. 53.9%, p = 0.002). In-hospital mortality as well as NOM failure rates were not significantly different between the 'prone' and 'non-prone' group (2.5 vs. 2.9%, p = 1.000; 0.0 vs. 4.4%, p = 0.362). Eleven patients with high-grade injuries were operated in prone position at median day 3 (IQR 3.0). None of these patients failed NOM. However, one patient with a grade IV splenic injury required immediate splenectomy after being operated in right-sided position on the day of admission. <br><br>CONCLUSION: In this single-center analysis, surgery in prone position was performed in a substantial number of patients with splenic/liver injuries without increasing the fNOM rate. However, caution should be used in patients with grade IV/V splenic injuries.<p /> <p>Language: en</p>",
language="en",
issn="0364-2313",
doi="10.1007/s00268-018-4739-y",
url="http://dx.doi.org/10.1007/s00268-018-4739-y"
}