Does splenectomy protect against immune-mediated complications in blunt trauma patients?
Activation of the innate immune system results from severe trauma and the resultant systemic inflammatory response is thought to mediate remote organ injury. In animal models, vagal-mediated innate immune responses have been shown to modulate proinflammatory cytokine release in response to trauma or sepsis. In those models, vagal nerve transaction and splenectomy decreased cytokine release and protected against lung injury and mortality. We hypothesized that, if similar mechanisms are active in humans, patients who require splenectomy for trauma would have better outcomes than injured patients without splenectomy. We performed a retrospective cohort study on 46,858 patients who sustained blunt liver or spleen injury utilizing the 2002 National Trauma Data Bank (NTDB). Blunt trauma patients who underwent splenectomy were compared with all patients with splenic injuries. Demographic parameters and the following outcome variables were compared: mortality, hospital length of stay (LOS), ICU length of stay (ILOS), mean ventilator days (VENT), and incidence of acute respiratory distress syndrome (ARDS). Groups were compared controlling for age, gender, injury severity score (ISS), emergency department (ED) blood pressure, and ED base deficit (BD) using multiple regression analyses. Patients that underwent splenectomy had significantly shorter LOS than patients who were managed nonoperatively or with splenorrhaphy: LOS,15.1 versus 19.3 d, P = 0.002; ILOS, 7.8 versus 10.6 d, P < 0.001; and VENT, 7.1 versus 11.4 d, P < 0.001. Adjusted mortality rates (OR 1.02; 95% CI 0.98-1.05; P = 0.29) and the reported incidence of ARDS were not significantly different between the two groups (2.4% versus 3.6%; P = 0.213). Patients who underwent splenectomy demonstrated better secondary outcomes than patients who were managed nonoperatively or with splenorrhaphy, even when controlling for injury severity and physiologic derangements. It is possible that the improved outcomes seen in the group undergoing splenectomy were due to favorable modulation of the human innate immune inflammatory response after trauma.
Crandall
Marie
M
Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, Illinois 60611, United States of America. mcrandall@northwestern.edu
Shapiro
Michael B
MB
West
Michael A
MA
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000293:injuries; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries / Q000601:surgery; D013156:Splenectomy; D018746:Systemic Inflammatory Response Syndrome / Q000276:immunology / Q000517:prevention & control*; D014949:Wounds, Nonpenetrating / Q000276:immunology* / Q000601:surgery*