Blunt splenic trauma: splenectomy increases early infectious complications: a prospective multicenter study.
BACKGROUND
The purpose of this study was to evaluate the effect of the method of splenic injury management on early infectious complications.


METHODS
Prospective observational, multicenter study which included all patients with blunt splenic injury surviving at least 72 hours. Epidemiologic and clinical data, grade of splenic injury, method of splenic management, and infectious complications during the initial hospitalization were collected according to a standardized collecting datasheet. Logistic regression analysis was used to identify independent risk factors for infectious complications.


RESULTS
During a 22-month period, 269 eligible patients were enrolled in the study. Overall, 105 (39.0%) patients were observed; 48 (17.8%) underwent successful angioembolization, 19 (7.1%) underwent splenorrhaphy, and 97 (36.1%) underwent splenectomy. Multivariate analysis adjusting for age, hypotension on admission, Glasgow Coma Scale, Injury Severity Score, Abbreviated Injury Scale, laparotomy, grade of splenic injury, and associated solid and hollow viscus injuries, showed that splenectomy had a significantly higher incidence of infectious complications than splenic preservation (adjusted odds ratio [95% confidence interval], 9.62 [3.04-30.30]; p < 0.001). A regression model analysis identified splenectomy, hypotension on admission, associated hollow viscus injury, and high Injury Severity Score as independent risk factors for infectious complications. Forward logistic regression analysis, which included only the 176 patients with grades III to V splenic injuries, identified splenectomy as the most significant independent risk factors for infection (adjusted odds ratio [95% confidence interval], 16.67 [3.76-71.43]; p < 0.001).


CONCLUSIONS
Splenectomy is an independent risk factor for early infectious complications. Splenic-preserving techniques should be considered more liberally.
LAC + USC Medical Center, University of Southern California, Los Angeles, California, USA. demetria@usc.edu
Demetrios
D
Demetriades
Thomas M
TM
Scalea
Elias
E
Degiannis
Galinos
G
Barmparas
Agathoklis
A
Konstantinidis
John
J
Massahis
Kenji
K
Inaba
D000328:Adult; D001424:Bacterial Infections / Q000209:etiology*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery*