title: Postdischarge complications following nonoperative management of blunt splenic injury.
abstract: BACKGROUND
  Nonoperative management (NOM) is the standard of care in majority of blunt splenic injuries. However, little is known about the postdischarge complications.
  
  
  METHODS
  Patients admitted for blunt splenic injury were identified in the California State Inpatient Database (2007 to 2011). We examined patterns and risk factors for postdischarge complications among these patients.
  
  
  RESULTS
  In total, 2,704 (61.45%) patients had NOM without splenic artery embolization (SAE) and 257 (5.84%) had NOM with adjunct SAE. Thirty-day readmission rate was higher in those who had adjunct SAE (12.84% vs 7.36%, P = .002). Subsequent operations during readmission were seen in 18.10% of readmitted patients and 38.10% of all patients were readmitted at nonindex hospitals. Major diagnoses on readmission were spleen injury (36.2%) and respiratory complications (9.05%). Adjunct SAE was an independent risk factor for readmission (adjusted odds ratio 1.82, 95% confidence interval 1.19 to 2.78).
  
  
  CONCLUSIONS
  Nearly one fifth of readmitted patients initially managed nonoperatively required an operative intervention. Improving predischarge assessments and postdischarge follow-up may reduce readmissions among these patients.
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Gil
authors.initials: G
authors.lastname: Freitas
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02120, USA.
authors.forename: Olubode A
authors.initials: OA
authors.lastname: Olufajo
authors.affiliation: Surgical ICU Translational Research Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Hammouda
authors.affiliation: Faculty of Arts and Sciences, Harvard University, Cambridge, MA 02138, USA.
authors.forename: Elissa
authors.initials: E
authors.lastname: Lin
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02120, USA.
authors.forename: Zara
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02120, USA.
authors.forename: Joaquim M
authors.initials: JM
authors.lastname: Havens
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02120, USA.
authors.forename: Reza
authors.initials: R
authors.lastname: Askari
authors.affiliation: Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02120, USA. Electronic address: asalim1@partners.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D002140:California; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D012307:Risk Factors; D013154:Spleen / Q000293:injuries*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000601:surgery / Q000628:therapy*
keywords: Abdominal injury; Nonoperative management; Readmission; Risk factors; Splenic injury; Trauma