The association between angioembolization and splenic salvage for isolated splenic injuries

• Published in: The Journal of surgical research 2018-09, Vol.229, p.150-155
• Main Authors: Rosenberg, Graeme M., Weiser, Thomas G., Maggio, Paul M., Browder, Timothy D., Tennakoon, Lakshika, Spain, David A., Staudenmayer, Kristan L.
• Format: Article
• Language: English
• Subjects: Adult; Angioembolization; Databases, Factual - statistics & numerical data; Embolization, Therapeutic - methods; Embolization, Therapeutic - statistics & numerical data; Female; Humans; Injury Severity Score; Logistic Models; Male; Middle Aged; Nonoperative management; Organ Sparing Treatments - methods; Organ Sparing Treatments - statistics & numerical data; Retrospective Studies; Spleen; Spleen - injuries; Spleen - surgery; Splenectomy; Splenectomy - statistics & numerical data; Trauma; Trauma Centers - statistics & numerical data; Young Adult
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2018.03.013

Recent data suggest improved splenic salvage rates when angioembolization (AE) is routinely employed for high-grade splenic injuries; however, protocols and salvage rates vary among centers. Adult patients with isolated splenic injuries were identified using the National Trauma Data Bank, 2013-2014. Patients were excluded if they underwent immediate splenectomy or died in the emergency department. To characterize patterns of AE, trauma centers were grouped into quartiles based on frequency of AE use. Unadjusted analyses and mixed-effects logistical regression controlling for center effects were performed. Five thousand and ninety three adult patients were identified. Overall, 705 (13.8%) underwent AE and 290 (5.7%) required a splenectomy. In unadjusted comparisons, splenectomy rates were lower for patients with severe spleen injuries who underwent AE (7% versus 11%, P = 0.02). In mixed-effect logistical regression patients with severe splenic injuries undergoing AE had a lower odds ratio (OR) for splenectomy (OR = 0.67, P = 0.04). Patients treated at centers in the highest quartile of AE use had a lower OR for splenectomy (OR = 0.58, P = 0.02). The use of AE in patients with isolated severe splenic injuries is associated with decreased splenectomy rates. There is an association between centers that perform AE frequently and reduced splenectomy rates.