Comparison of Timing of Definitive Pelvic Fixation in Pelvic Fracture Treated with Preperitoneal Pelvic Packing or Angioembolization

Authors

Junsik Kwon, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA.
Timothy Allison-Aipa, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA.
Bishoy Zakhary, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA.
Bruno C. Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA.
Matthew Firek, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA.
Raul Coimbra, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Riverside University Health System, Moreno Valley, CA.

Document Type

Journal Article

Publication Date

2-11-2025

Journal

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000001354

Abstract

BACKGROUND: Preperitoneal pelvic packing (PPP) and angioembolization (AE) are current hemostatic techniques in bleeding pelvic fracture patients. Concerns exist that PPP may delay definitive internal fixation of pelvic fractures. This study aims to determine whether PPP results in delayed internal fixation compared to AE. STUDY DESIGN: A retrospective cohort study was conducted using the Trauma Quality Improvement Program database from 2017 to 2021. Adults with isolated pelvic fractures requiring transfusion within 24 hours were included. Patients underwent internal fixation and received either PPP (n=90) or AE only (n=253). Inverse probability of treatment weighting was used to adjust for confounding variables. The primary outcome was time from admission to internal fixation; secondary outcomes included in-hospital mortality and hospital resource utilization. RESULTS: Time to definitive fixation was not significantly different between groups (PPP median 51.4 hours vs. AE median 37.5 hours; p=0.071). In-hospital mortality was higher in the PPP group (4.4% vs. 0.6%; p=0.009). The PPP group had longer ICU and hospital stays, extended mechanical ventilation duration, and higher rates of acute kidney injury and severe sepsis. No significant difference in transfusion volume within 4 hours was observed between the groups. CONCLUSIONS: PPP does not significantly delay definitive internal fixation. However, the implementation of PPP for patients with pelvic fractures may be associated with increased complications and hospital resource utilization compared to AE alone as a hemostatic measure.

APA Citation

Kwon, Junsik; Allison-Aipa, Timothy; Zakhary, Bishoy; Coimbra, Bruno C.; Firek, Matthew; and Coimbra, Raul, "Comparison of Timing of Definitive Pelvic Fixation in Pelvic Fracture Treated with Preperitoneal Pelvic Packing or Angioembolization" (2025). GW Authored Works. Paper 6597.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6597

Department

School of Medicine and Health Sciences Student Works