Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy.
BACKGROUND
Retrospective studies concerning the operative preservation and nonoperative management of splenic injuries in patients with splenic trauma have been published; however, few studies have analyzed prospectively the results and early complication rates of a defined management in splenic injury.


METHODS
From 1986 to 2006, adult patients with blunt splenic injuries were evaluated prospectively with the intent of splenic preservation. Hemodynamically unstable patients underwent laparotomy. Stable patients were treated conservatively regardless of the grade of splenic injury determined by ultrasound and/or CT scan.


RESULTS
During a 20-year period, 155 patients were prospectively evaluated. In 98 patients (63%), the spleen could be preserved by nonoperative (64 patients, 65%) or operative (34 patients, 35%) treatment and 57 patients (37%) needed splenectomy. There were no differences in age, sex, or trauma score between the groups, but a higher early infection rate in patients with splenectomy compared with patients with splenic preservation (p < 0.005) was observed, even if the patients were matched with respect to multiple trauma using the Injury Severity Score (p < 0.01).


CONCLUSIONS
Splenic preservation in patients with blunt splenic injury by operative or nonoperative treatment leads to lower early infection rates in adults and, therefore, should be advocated.
Department of Surgery, Kantonsspital, 8208, Schaffhausen, Switzerland.
Jean-Marc
JM
Gauer
Susanne
S
Gerber-Paulet
Christian
C
Seiler
Walter Paul
WP
Schweizer
D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology*; D013154:Spleen / Q000293:injuries*; D013156:Splenectomy; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult