BACKGROUND: Strategies for splenic preservation for trauma patients have gained acceptance; however, meaningful outcome evaluations have not been performed. To better understand the consequences of managing patients with splenic injuries, the short-term outcomes of different types of management strategies were examined. We defined splenic preservation as observation of splenic injury, splenic embolization, and splenorrhaphy. We defined splenic salvage as splenic embolization and splenorrhaphy. METHODS: Retrospective descriptive study examining splenic injury management of adult patients at an urban level 1 trauma center. RESULTS: During 31 months, 170 splenic injuries were captured by the trauma registry. Average age was 31.7 years, and the average Injury Severity Score (ISS) was 22.7; patients had multiple associated injuries. The average length of stay was 15.7 days, and mortality that was not associated with splenic injury was 10%. Fifty-eight patients underwent immediate splenectomy, with 3 patients requiring percutaneous drainage for pancreatic leaks and 1 patient requiring reoperation for a gastrocutaneous fistula (overall morbidity 6.9%). Eighty five patients were managed nonoperatively, with 10 patients (11.9%) failing expectant management; they underwent subsequent splenectomies. Eleven patients were managed by splenic artery embolization. Three patients (27.2%) required further intervention; 1 required re-embolization; and 2 required splenectomy. Sixteen patients underwent surgical splenorrhaphy, with 2 patients failing (12.5%), thus requiring eventual splenectomies. Morbidity for splenic preservation (observation, splenic embolization, and splenorrhaphy) was 13.4%, whereas morbidity for splenic salvage (embolization and splenorrhaphy) was 18.5%. CONCLUSIONS: In the adult population, splenic preservation has 2-fold and splenic salvage close to 3-fold morbidity compared with immediate splenectomy in management of patients with blunt and penetrating splenic injuries.
BACKGROUND: Strategies for splenic preservation for traumapatients have gained acceptance; however, meaningful outcome evaluations have not been performed. To better understand the consequences of managing patients with splenic injuries, the short-term outcomes of different types of management strategies were examined. We defined splenic preservation as observation of splenic injury, splenic embolization, and splenorrhaphy. We defined splenic salvage as splenic embolization and splenorrhaphy. METHODS: Retrospective descriptive study examining splenic injury management of adult patients at an urban level 1 trauma center. RESULTS: During 31 months, 170 splenic injuries were captured by the trauma registry. Average age was 31.7 years, and the average Injury Severity Score (ISS) was 22.7; patients had multiple associated injuries. The average length of stay was 15.7 days, and mortality that was not associated with splenic injury was 10%. Fifty-eight patients underwent immediate splenectomy, with 3 patients requiring percutaneous drainage for pancreatic leaks and 1 patient requiring reoperation for a gastrocutaneous fistula (overall morbidity 6.9%). Eighty five patients were managed nonoperatively, with 10 patients (11.9%) failing expectant management; they underwent subsequent splenectomies. Eleven patients were managed by splenic artery embolization. Three patients (27.2%) required further intervention; 1 required re-embolization; and 2 required splenectomy. Sixteen patients underwent surgical splenorrhaphy, with 2 patients failing (12.5%), thus requiring eventual splenectomies. Morbidity for splenic preservation (observation, splenic embolization, and splenorrhaphy) was 13.4%, whereas morbidity for splenic salvage (embolization and splenorrhaphy) was 18.5%. CONCLUSIONS: In the adult population, splenic preservation has 2-fold and splenic salvage close to 3-fold morbidity compared with immediate splenectomy in management of patients with blunt and penetrating splenic injuries.
Authors: Federico Coccolini; Giulia Montori; Fausto Catena; Yoram Kluger; Walter Biffl; Ernest E Moore; Viktor Reva; Camilla Bing; Miklosh Bala; Paola Fugazzola; Hany Bahouth; Ingo Marzi; George Velmahos; Rao Ivatury; Kjetil Soreide; Tal Horer; Richard Ten Broek; Bruno M Pereira; Gustavo P Fraga; Kenji Inaba; Joseph Kashuk; Neil Parry; Peter T Masiakos; Konstantinos S Mylonas; Andrew Kirkpatrick; Fikri Abu-Zidan; Carlos Augusto Gomes; Simone Vasilij Benatti; Noel Naidoo; Francesco Salvetti; Stefano Maccatrozzo; Vanni Agnoletti; Emiliano Gamberini; Leonardo Solaini; Antonio Costanzo; Andrea Celotti; Matteo Tomasoni; Vladimir Khokha; Catherine Arvieux; Lena Napolitano; Lauri Handolin; Michele Pisano; Stefano Magnone; David A Spain; Marc de Moya; Kimberly A Davis; Nicola De Angelis; Ari Leppaniemi; Paula Ferrada; Rifat Latifi; David Costa Navarro; Yashuiro Otomo; Raul Coimbra; Ronald V Maier; Frederick Moore; Sandro Rizoli; Boris Sakakushev; Joseph M Galante; Osvaldo Chiara; Stefania Cimbanassi; Alain Chichom Mefire; Dieter Weber; Marco Ceresoli; Andrew B Peitzman; Liban Wehlie; Massimo Sartelli; Salomone Di Saverio; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-08-18 Impact factor: 5.469
Authors: Jing-Jing Rong; Dan Liu; Ming Liang; Qing-Hua Wang; Jing-Yang Sun; Quan-Yu Zhang; Cheng-Fei Peng; Feng-Qi Xuan; Li-Jun Zhao; Xiao-Xiang Tian; Ya-Ling Han Journal: Mil Med Res Date: 2017-05-30
Authors: Roy Spijkerman; Michel Paul Johan Teuben; Fatima Hoosain; Liezel Phyllis Taylor; Timothy Craig Hardcastle; Taco Johan Blokhuis; Brian Leigh Warren; Luke Petrus Hendrikus Leenen Journal: World J Emerg Surg Date: 2017-07-25 Impact factor: 5.469