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Updated: May 20, 2026
Application of Laparoscopic Partial Splenectomy with Total Blood Flow Occlusion in Benign Splenic Lesions
Published on: December 20, 2024
Less is more: management of pediatric splenic injury
Justin Lee1, Kevin P Moriarty, David B Tashjian
1Department of Surgery, St Elizabeth Medical Center, Tufts University School of Medicine, 24A Winship St, Boston, MA 02155, USA. Justin.Lee@tufts.edu
Insights
Pediatric splenic injury management shows fewer splenectomies and increased angiography. Rural children may face more operative management, highlighting potential access disparities in nonoperative care.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Health Services Research
Background:
- Nonoperative management (NOM) is preferred for pediatric splenic injuries.
- Trends in NOM utilization and outcomes require ongoing analysis.
Purpose of the Study:
- To analyze national trends in the nonoperative management of pediatric splenic injury.
- To evaluate changes in splenectomy, angiography, and transfusion rates.
- To identify factors associated with operative versus nonoperative management.
Main Methods:
- Retrospective cohort analysis of pediatric splenic injury hospitalizations.
- Utilized data from the National Inpatient Sample and Kids' Inpatient Database (2000-2008).
- Calculated rates of splenectomy, angiography, and transfusion.
Main Results:
- Splenectomy rates decreased significantly from 18.25% to 10.86%.
- Angiography use more than doubled (2.43% to 6.94%), and transfusion rates increased (7.71% to 11.49%).
- Operative management was linked to longer hospital stays and higher costs; rural location was associated with increased operative management.
Conclusions:
- Fewer children undergo splenectomy, with increased use of angiography for pediatric splenic injury.
- Rural location may be an independent risk factor for operative management.
- Further research is needed to address potential disparities in access to aggressive nonoperative management.
Objective:
To analyze national trends in the nonoperative management of pediatric splenic injury.
Design:
Retrospective cohort analysis.
Patients:
All children and adolescents 18 years or younger from 2 national databases who were hospitalized with pediatric splenic injury.
Setting:
Data from 9 years of the National Inpatient Sample database (2000-2008) and 3 years of Kids' Inpatient Database (2000, 2003, and 2006).
Main Outcome Measures:
We calculated and chronicled rates of splenectomy, angiography, and transfusion from 2000 to 2008.
Results:
During the study period, the rate of splenectomy decreased from 18.25% to 10.86%. Changes in nonoperative management included more than a 2-fold increase in angiography, from 2.43% to 6.94%, and a significant increase in transfusion, from 7.71% to 11.49%. Operative management was associated with increased length of stay (9.15 vs 6.52 days) and higher mean total hospital charges ($74 981.26 vs $36 156.30). Cases occurring in rural locations were more likely to undergo operative management (odds ratio, 1.24 [95% CI, 1.18-1.31]; P < .001), but less likely to undergo angiography (0.82 [0.76-0.89]; P < .001).
Conclusions:
Children with pediatric splenic injury are undergoing fewer splenectomies but more angiography. Rural location may be an independent risk factor for operative management. Further studies are needed to assess for disparity in access to and availability of aggressive nonoperative management.
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