Short-term outcomes of splenectomy avoidance in trauma patients

Background: Strategies for splenic preservation for trauma patients have gained acceptance; however, meaningful outcome evaluations have not been performed. To better understand the consequences of managing patients with splenic injuries, the short-term outcomes of different types of management strategies were examined. We defined splenic preservation as observation of splenic injury, splenic embolization, and splenorrhaphy. We defined splenic salvage as splenic embolization and splenorrhaphy. Methods: Retrospective descriptive study examining splenic injury management of adult patients at an urban level 1 trauma center. Results: During 31 months, 170 splenic injuries were captured by the trauma registry. Average age was 31.7 years, and the average Injury Severity Score (ISS) was 22.7; patients had multiple associated injuries. The average length of stay was 15.7 days, and mortality that was not associated with splenic injury was 10%. Fifty-eight patients underwent immediate splenectomy, with 3 patients requiring percutaneous drainage for pancreatic leaks and 1 patient requiring reoperation for a gastrocutaneous fistula (overall morbidity 6.9%). Eighty five patients were managed nonoperatively, with 10 patients (11.9%) failing expectant management; they underwent subsequent splenectomies. Eleven patients were managed by splenic artery embolization. Three patients (27.2%) required further intervention; 1 required re-embolization; and 2 required splenectomy. Sixteen patients underwent surgical splenorrhaphy, with 2 patients failing (12.5%), thus requiring eventual splenectomies. Morbidity for splenic preservation (observation, splenic embolization, and splenorrhaphy) was 13.4%, whereas morbidity for splenic salvage (embolization and splenorrhaphy) was 18.5%. Conclusions: In the adult population, splenic preservation has 2-fold and splenic salvage close to 3-fold morbidity compared with immediate splenectomy in management of patients with blunt and penetrating splenic injuries.