Splenectomy in patients with traumatic brain injury: protective or harmful? A National Trauma Data Bank analysis.
BACKGROUND
Experimental data have demonstrated a potential survival benefit for animals undergoing splenectomy immediately after traumatic brain injury. The aim of this study was to investigate the effect of splenectomy on survival in patients with moderate or severe traumatic brain injury (TBI).


METHODS
This is a National Trauma Data Bank (2002-2009) analysis and included patients sustaining moderate or severe blunt head trauma (head Abbreviated Injury Scale [AIS] score, 3-5), with an associated splenic injury and an exploratory laparotomy. The population was divided into two arms: those that had a splenectomy and those who did not. The primary outcome was in-hospital mortality. Logistic regression was performed to adjust for factors that were significantly different between the study groups.


RESULTS
During the 9-year study period, 2,625 patients met the criteria for inclusion in the analysis. Of these, 1,450 (55%) had a splenectomy, and 1,175 (45%) did not. Mortality was 13% for the splenectomized compared with 9% for the nonsplenectomized population (p = 0.001). After logistic regression, mortality remained significantly higher in the splenectomized population (adjusted odds ratio [AOR], 1.62; 95% confidence interval [CI], 1.16-2.26; p = 0.005). After stratification according to the severity of brain injury, the association between splenectomy and increased mortality persisted for both patients with moderate head injury (8% vs. 6%; AOR, 2.43; 95% CI, 1.26-4.71; p = 0.008) and for patients with severe head injury (17% vs. 10%; AOR, 1.49; 95% CI, 1.03-2.19; p = 0.036).


CONCLUSIONS
Splenectomy was independently associated with increased mortality in patients with moderate or severe TBI. This finding warrants further investigation regarding splenic preservation in patients with TBI.


METHODS
Therapeutic study, level IV.
From the Los Angeles County + University of Southern California Medical Center, Los Angeles, California.
Pedro G
PG
Teixeira
Efstathios
E
Karamanos
Obi T
OT
Okoye
Peep
P
Talving
Kenji
K
Inaba
Lydia
L
Lam
Demetrios
D
Demetriades
D015998:Abbreviated Injury Scale; D000328:Adult; D001930:Brain Injuries / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D013156:Splenectomy / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States