Short-term outcomes of splenectomy avoidance in trauma patients.
BACKGROUND
Strategies for splenic preservation for trauma patients have gained acceptance; however, meaningful outcome evaluations have not been performed. To better understand the consequences of managing patients with splenic injuries, the short-term outcomes of different types of management strategies were examined. We defined splenic preservation as observation of splenic injury, splenic embolization, and splenorrhaphy. We defined splenic salvage as splenic embolization and splenorrhaphy.


METHODS
Retrospective descriptive study examining splenic injury management of adult patients at an urban level 1 trauma center.


RESULTS
During 31 months, 170 splenic injuries were captured by the trauma registry. Average age was 31.7 years, and the average Injury Severity Score (ISS) was 22.7; patients had multiple associated injuries. The average length of stay was 15.7 days, and mortality that was not associated with splenic injury was 10%. Fifty-eight patients underwent immediate splenectomy, with 3 patients requiring percutaneous drainage for pancreatic leaks and 1 patient requiring reoperation for a gastrocutaneous fistula (overall morbidity 6.9%). Eighty five patients were managed nonoperatively, with 10 patients (11.9%) failing expectant management; they underwent subsequent splenectomies. Eleven patients were managed by splenic artery embolization. Three patients (27.2%) required further intervention; 1 required re-embolization; and 2 required splenectomy. Sixteen patients underwent surgical splenorrhaphy, with 2 patients failing (12.5%), thus requiring eventual splenectomies. Morbidity for splenic preservation (observation, splenic embolization, and splenorrhaphy) was 13.4%, whereas morbidity for splenic salvage (embolization and splenorrhaphy) was 18.5%.


CONCLUSIONS
In the adult population, splenic preservation has 2-fold and splenic salvage close to 3-fold morbidity compared with immediate splenectomy in management of patients with blunt and penetrating splenic injuries.
Kaseje
Neema
N
Department of Surgery, Boston University Medical Center, Boston, MA, USA.
Agarwal
Suresh
S
Burch
Miguel
M
Glantz
Andrew
A
Emhoff
Timothy
T
Burke
Peter
P
Hirsch
Erwin
E
D000328:Adult; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries* / Q000601:surgery*; D013156:Splenectomy / Q000706:statistics & numerical data*; D013526:Surgical Mesh / Q000706:statistics & numerical data; D014193:Trauma Centers; D014505:Urban Population; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery