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Operative Versus Nonoperative Management in High-Grade Blunt Splenic Injuries: A 10-year Analysis.

Justin Gerard¹, Chassidy Martin¹, Lucy Reid¹

¹Department of Surgery, University of Tennessee Medical Center Knoxville, Knoxville, Tennessee.

The Journal of Surgical Research

|July 13, 2026

Summary

Nonoperative management (NOM) for high-grade blunt splenic injuries shows comparable mortality to operative management (OM). This decade-long study found NOM has a low failure rate, with injury severity and hypotension driving patient risk.

Keywords:

Blunt Embolization High-Grade Non-Operative Operative Spleen Splenectomy

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Application of Laparoscopic Partial Splenectomy with Total Blood Flow Occlusion in Benign Splenic Lesions

Application of Laparoscopic Partial Splenectomy with Total Blood Flow Occlusion in Benign Splenic Lesions

Published on: December 20, 2024

Area of Science:

Trauma Surgery
Surgical Outcomes
Emergency Medicine

Background:

High-grade blunt splenic injuries (AAST Grades IV-V) pose significant hemorrhage risks.
Real-world, long-term outcomes of protocolized management for these injuries are limited.
This study examines a decade of outcomes for AAST Grade IV-V blunt splenic injuries at a Level I trauma center.

Purpose of the Study:

To compare operative management (OM) and nonoperative management (NOM) for high-grade blunt splenic injuries.
To evaluate the long-term outcomes and failure rates of NOM.
To identify factors influencing mortality and adverse outcomes in blunt splenic injuries.

Main Methods:

A retrospective review of adult patients with AAST Grade IV-V blunt splenic injury from 2015-2024.
Management prioritized OM for persistent hypotension and NOM with splenic artery embolization for stable patients.
In-hospital mortality, NOM failure (reintervention), and a composite outcome were analyzed using multivariable regression.

Main Results:

Of 386 patients, 50.8% underwent OM and 49.2% NOM; 68.4% of NOM patients received splenic artery embolization.
NOM failure occurred in 6.8% of patients.
Adjusted analysis showed NOM was not associated with increased mortality (OR 1.04) or composite outcomes (OR 1.02). Mortality correlated with injury severity and hypotension. OM resulted in a longer hospital stay.

Conclusions:

After a decade of physiology-driven care, NOM for high-grade blunt splenic injuries has a low failure rate.
NOM achieves outcomes comparable to OM regarding mortality and major adverse events.
Injury severity and hypotension are the primary drivers of risk in these patients.