Improved outcomes in the non-operative management of XXXX .

@entity5394 @entity39 @entity409 @entity1188 @entity733 @entity4917 @entity99 @entity130
OBJECTIVES: Non-operative management has become the treatment of choice in the majority of @entity99 . The aim of this study was to assess the changes in primary treatment and outcomes in a single Dutch Level 1 @entity130 centre with wide experience in @entity4917 ( @entity4917 ). METHODS: The prospective @entity130 registry was retrospectively analysed for 7-year periods before (Period 1) and after ( @entity5394 ) the introduction of @entity4917 . The primary outcome was the failure rate of primary treatment defined as @entity99 or re-bleeding requiring radiologic or operative (re)interventions. Secondary outcomes were @entity409 . RESULTS: Despite an increase in high-grade @entity99 , the incidence of primary non-operative management more than doubled over the two periods, from 33% (20 of 61 cases) in Period 1 to 72% (84 of 116 cases) in @entity5394 (P < 0.001). The failure rate of primary treatment in Period 1 was 18% (11/61), compared with 11% (13/116) in @entity5394 (P= 0.21). Complication rates were 23% (14/61) and 16% (18/116) in @entity5394 , respectively (P= 0.22). Liver-related mortality rates were 10% (6/61) and 3% @entity5394 , respectively (P= 0.095). The increase in the frequency of non-operative management was even higher in high-grade injuries, in which outcomes were improved. In high-grade injuries in @entity5394 , failure rates decreased from 45% (9/20) to 20% (11/55) (P= 0.041), liver-related mortality decreased from 30% (6/20) to 7% (4/55) (P= 0.019) and complication rates fell from 60% (12/20) to 27% (15/55) (P= 0.014). @entity1188 or @entity39 and @entity733 formation seemed to occur more frequently with @entity4917 . CONCLUSIONS: Overall, liver-related mortality, treatment failure and complication rates remained constant despite an increase in non-operative management. However, in high-grade injuries outcomes improved after the introduction of @entity4917 .
