ArticleJournal of the colleges of medicine of South Africa2026
Outcomes of non-operative management of liver trauma in a low- and middle-income country: A single-centre experience from South Africa.
Article in Journal of the colleges of medicine of South Africa, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Non-operative management (NOM) has become the standard of care for haemodynamically stable patients with liver trauma, yet robust data from low- and middle-income countries (LMICs) remain scarce, particularly in settings with a high burden of penetrating trauma. Methods: This single-centre retrospective cohort study analysed 251 adult patients with liver injuries managed non-operatively at a major trauma centre in Johannesburg, South Africa, between January 2017 and December 2023. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day survival and associated injury patterns. Results: Overall mortality was 1.20% (3/251; Wilson 95% confidence interval [CI]: 0.41-3.45). All deaths occurred within 30 days. Admission lactate was the only variable significantly associated with mortality in the univariate analysis (odds ratio [OR]: 1.53 per 1 mmol/L increase, 95% CI: 1.11-2.10, Conclusion: In appropriately selected haemodynamically stable patients, NOM achieved excellent outcomes despite a substantial polytrauma burden. Physiology, rather than anatomic grade or associated injury pattern, determined survival. These findings support physiology-led selection in resource-constrained environments. Contribution: This study provides key insights into the real-world outcomes of non-operative management (NOM) of liver trauma in a high-volume, resource-constrained South African trauma centre. It demonstrates exceptionally low mortality (1.20%) with physiology-led patient selection despite a high burden of penetrating trauma and polytrauma. The primary contribution is evidence that admission lactate is a strong predictor of mortality, while anatomic injury grade (AAST) is not. These findings reinforce physiology-guided decision-making in LMIC settings and align directly with the journal's focus on clinical practice and surgical outcomes in Southern Africa.
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