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Risk Factors for Failure of Splenic Angioembolization: A Multicenter Study of Level I Trauma Centers
Brittany Bankhead-Kendall1, Pedro Teixeira1, Tashinga Musonza2
1Department of Surgery and Perioperative Care, Dell Seton Medical Center at the University of Texas at Austin, Austin, Texas.
The Journal of Surgical Research
|August 30, 2020
Summary
Angioembolization (AE) effectively manages splenic injuries in most cases. However, early blood transfusion is linked to AE failure, increased complications, and higher mortality, underscoring the need for careful patient monitoring.
Area of Science:
- Trauma Surgery
- Interventional Radiology
- Surgical Outcomes
Background:
- Splenic injuries are common in trauma.
- Angioembolization (AE) is a key adjunct to nonoperative management (NOM) for splenic injuries.
- Predictors of AE failure in splenic injuries require further investigation.
Purpose of the Study:
- To identify factors associated with angioembolization (AE) failure in patients undergoing nonoperative management (NOM) of splenic injuries.
- To evaluate the impact of AE failure on patient outcomes, including mortality and resource utilization.
Main Methods:
- Retrospective multicenter study of adult trauma patients with splenic injuries who underwent AE (2010-2017).
- Data collected included patient physiology, injury grade, transfusion requirements, and embolization technique.
- Primary outcome was NOM failure (requiring splenectomy); secondary outcomes included mortality, complications, and length of stay.
Main Results:
- Angioembolization (AE) was successful in 92% of cases.
- Failure of NOM was significantly associated with blood transfusion within the first 24 hours (P=0.009) and massive transfusion (P=0.01).
- Patients experiencing NOM failure had higher rates of complications, longer intensive care unit and hospital stays, and increased mortality (15% vs. 3%).
Conclusions:
- Angioembolization (AE) is an effective treatment for splenic injuries, achieving NOM in the majority of patients.
- Early blood transfusion is an independent predictor of AE failure in splenic injuries.
- Failure of NOM is associated with significantly increased morbidity and mortality, highlighting the importance of vigilant post-embolization monitoring.
