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Splenic artery angioembolization for high-grade splenic injury: Are we wasting money?
Lara Senekjian1, Joseph Cuschieri2, Bryce R H Robinson2
1Division of Trauma and Burns, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359796, Seattle, WA, 98104, USA; Department of Surgery, University of California San Francisco, East Bay - Alameda Health System, 1411 E. 31st Street, Oakland, CA, 94602, USA.
Background:
Non-operative management (NOM) is accepted treatment of splenic injury, but this may fail leading to splenectomy. Splenic artery embolization (SAE) may improve rate of salvage. The purpose is to determine the cost-utility of the addition of SAE for high-grade splenic injuries.
Methods:
A cost-utility analysis was developed to compared NOM to SAE in patients with blunt splenic injury. Sensitivity analysis was completed to account for uncertainty. Utility outcome was quality-adjusted life years (QALY).
Results:
For patients with grade III, IV and V injury NOM is the dominant strategy. The probability of NOM being the more cost-effective strategy is 87.5% in patients with grade V splenic injury. SAE is not the favored strategy unless the probability of failure of NOM is greater than 70.0%.
Conclusion:
For grade III-V injuries, NOM without SAE yields more quality-adjusted life years. NOM without SAE is the most cost-effective strategy for high-grade splenic injuries.
