Safety and effectiveness of nonoperative management in liver lacerations: a retrospective cohort study.

BACKGROUND

Liver trauma remains a major contributor to morbidity in patients with abdominal injuries. Although nonoperative management (NOM) is widely accepted in hemodynamically stable patients, the relationship between American Association for the Surgery of Trauma (AAST) injury grade, laboratory parameters, transfusion requirements, and the need for surgical intervention remains unclear.

METHODS

This retrospective observational study included 53 patients with radiologically or intraoperatively confirmed liver lacerations treated at a tertiary surgical center between October 2024 and May 2025. Data collected included demographics, vital signs, AAST injury grade, laboratory values, transfusion requirements, imaging use, and clinical outcomes. Statistical analyses were performed using analysis of variance (ANOVA), chi-square/Fisher's exact tests, and logistic regression.

RESULTS

The mean age was 41.4 years, with 67.9% of patients being male. The most common mechanism of injury was motor vehicle accidents (56.6%). On admission, 64.2% of patients had AAST grade I-II injuries, while 7.5% had grade IV injuries. NOM was successful in 81.1% of cases, with 18.9% requiring operative intervention. No in-hospital mortality was observed. Changes in hemoglobin and hematocrit levels were not significantly associated with injury grade or the need for surgery. However, transfusion requirements increased with injury severity, including erythrocyte suspension (p=0.006) and fresh frozen plasma (p<0.001). Follow-up imaging (n=25) demonstrated stable or improved findings in 96% of patients. Logistic regression analysis did not identify independent predictors of surgical intervention.

CONCLUSION

NOM of liver lacerations is safe and effective, with excellent outcomes and no mortality observed in this cohort. Although AAST injury grade alone did not predict the need for surgery, transfusion requirements correlated with injury severity, high-lighting their value as practical indicators in clinical decision-making.