Outcomes of non-operative management of liver trauma in a low- and middle-income country: A single-centre…

Cohort studyJournal of the colleges of medicine of South Africa· 2026

Outcomes of non-operative management of liver trauma in a low- and middle-income country: A single-centre experience from South Africa.

Isabella M Joubert, Mozamil Mohamed, Maeyane S Moeng

Emergency Trauma CareCohort studyClinical practice

Non-operative management of liver trauma achieved very low in-hospital mortality.

Outcomes of non-operative management of liver trauma in a low- and middle-income country: A single-centre experience from South Africa.

Isabella M Joubert … Maeyane S Moeng

Journal of the colleges of medicine of South Africa · 2026

Background

Non-operative management (non-operative management) has become the standard of care for haemodynamically stable patients with liver trauma, yet robust data from low- and middle-income countries (low- and middle-income countries) 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.

n = 251 adult

Results

in-hospital deaths were rare, non-operative management is safe

OR 1.48 (95% CI 1.08 to 2.03)

null 1

1.08

2.03

CI excludes the null - significant

More results

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, p = 0.009).

Sensitivity analysis using Firth's penalised logistic regression yielded consistent results (penalised OR: 1.48, 95% CI: 1.08-2.03, p = 0.015).

More results

Chest injuries were the most common associated injury (42.6%).

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Conclusion · 1 of 3

In appropriately selected haemodynamically stable patients, non-operative management achieved excellent outcomes despite a substantial polytrauma burden.

Conclusion · 2 of 3

Physiology, rather than anatomic grade or associated injury pattern, determined survival. These findings support physiology-led selection in resource-constrained environments.

Conclusion · 3 of 3

CONTRIBUTION: This study provides key insights into the real-world outcomes of non-operative management (non-operative management) of liver trauma in a high-volume, resource-constrained South African trauma centre.

Outcomes of non-operative management of liver trauma in a low- and middle-income country: A single-centre experience from South Africa.

Outcomes of non-operative management of liver trauma in a low- and middle-income country: A single-centre experience from South Africa.

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