Background: Thromboprophylaxis protocols in liver surgery vary greatly worldwide. Due to limited research, there is no consensus whether the administration of thromboprophylaxis should be initiated pre-or postoperatively. Methods: Patients undergoing liver resection in Helsinki University Hospital between 2014 and 2017 were reviewed retrospectively. Initiation of thromboprophylaxis was changed in the institution in the beginning of 2016 from postoperative to preoperative. Patients were classified into two groups for analyses: thromboprophylaxis initiated preoperatively (Preop-group) or postoperatively (Postop-group). The incidences of VTE and haemorrhage within 30 days of surgery were compared between these groups. Patients with permanent anticoagulation were excluded. Results: A total of 512 patients were included to the study (Preop, n = 253, Postop, n = 259). The incidence of VTE was significantly lower in the Preop-group compared to the Postop-group (3 (1.2%) vs. 25 (9.7%), P = <.0001), mainly due to a lower incidence of pulmonary embolisms in the Preop-group (3 (1.2%) vs. 24 (9.3%), P < .0001). The rates of posthepatectomy haemorrhage within 30 days of surgery were similar (Preop 38 (15.0%) vs. Postop 36 (13.9%), p = .719). Conclusion: Initiating thromboprophylaxis preoperatively may reduce the incidence of postoperative VTE without affecting the incidence of posthepatectomy haemorrhage in patients undergoing liver resection.
had liver injury, 280 splenic injury and 83 combined hepatic/splenic injury. Initial NOM for both groups was performed in 82.6% of patients, of which 1.2% received angiographic embolisation and/or ERCP. All other NOM cases were managed through bed rest without primary intervention. The secondary failure rate of NOM was 3.5%. Reasons for failure of NOM were: haemodynamic instability due to persistent or secondary bleeding, extent of intraabdominal heamatoma and infectious complications.Overall mortality rate was below 5% (p<0.0001), in the NOM group 3.5% (p=0.006), both decreasing significantlyover the study period. Conclusion: NOM is the standard of care for blunt hepatic and splenic injuries and successful in >96% of all patients. This rate was quite constant over 17 years (p=0.515). Our cohort represents one of the largest Western European single centre experience available in the literature.
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