Outcomes of Isolated Severe Blunt Splenic Injury

Area of Science:

• Trauma Surgery
• Surgical Outcomes
• Emergency Medicine

Background:

• Management of blunt splenic injury is shifting towards nonoperative strategies for splenic salvage.
• Splenic angioembolization (SAE) is increasingly considered, even in hypotensive patients.
• Outcomes of these evolving strategies require further investigation.

Purpose of the Study:

• To compare the outcomes of three primary treatment approaches for severe blunt splenic injury.
• Evaluate mortality and complication rates across different management strategies.

Main Methods:

• Retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database (2017-2022).
• Included adults with isolated, severe blunt splenic injury (Abbreviated Injury Scale score ≥3).
• Compared open splenectomy (OS), splenic angioembolization (SAE), and observation using multivariable Cox regression.

Main Results:

• No significant difference in mortality was observed across OS, SAE, and observation groups.
• Morbidity was significantly lower in the SAE and observation groups compared to OS.
• In hypotensive patients, SAE and observation showed no mortality difference but shorter hospital stays.
• Failure of nonoperative management (SAE or observation) led to higher morbidity and longer hospital stays compared to initial OS.

Conclusions:

• Nonoperative management (SAE or observation) is associated with favorable outcomes for isolated severe blunt splenic injury, even in hypotensive patients.
• Splenic salvage through nonoperative approaches may be preferred with careful patient selection.
• Failure of nonoperative management increases morbidity without increasing mortality.