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Preperitoneal pelvic packing in isolated severe pelvic fractures is associated with higher mortality and venous thromboembolism: A matched-cohort study.

Kolitsas A, Williams EC, Lewis MR, Benjamin ER, Demetriades D. Preperitoneal pelvic packing in isolated severe pelvic fractures is associated with higher mortality and venous thromboembolism: A matched-cohort study. American journal of surgery. 2024 Jul 3; 236:115828.

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Abstract:

INTRODUCTION: Preperitoneal pelvic packing (PPP) has been advocated as a damage control procedure for pelvic fracture bleeding, despite of weak evidence. METHODS: Matched cohort study, TQIP database. Patients with isolated severe blunt pelvic fractures (pelvis abbreviated injury score [AIS] ? =  ?3, AIS = 2 in all other body regions) were included. Patients who underwent PPP were matched to patients with no PPP, 1:3 nearest propensity score. Matching was performed based on demographics, vital signs on admission, comorbidities, injury characteristics, type and timing of initiation of VTE prophylaxis, and additional procedures including laparotomy, REBOA, and angioembolization. RESULTS: 64 patients with PPP were matched with 182 patients with No-PPP. PPP patients had higher in-hospital mortality (14.1 ?% vs 2.2 ?% p ? <  ?0.001) and higher rates of VTE and DVT (VTE: 14.1 ?% vs 4.4 ?% p ? =  ?0.018, DVT: 10.9 ?% vs 2.2 ?% p ? =  ?0.008). CONCLUSION: PPP is associated with worse survival outcomes and increased rate of VTE and DVT complications.




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