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Variation in the Use of Urgent Splenectomy After Blunt Splenic Injury in Adults

Zarzaur, Ben L. MD, MPH; Croce, Martin A. MD; Fabian, Timothy C. MD

The Journal of Trauma: Injury, Infection, and Critical Care: November 2011 - Volume 71 - Issue 5 - p 1333-1339
doi: 10.1097/TA.0b013e318224d0e4
Original Article
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Objective: Recent reports indicate that mortality after trauma center admission may be directly related to the rate of operative intervention after blunt solid organ injury. These findings bring into question the role of urgent splenectomy after blunt splenic injury (BSI). The purpose of this study was to determine the role of urgent splenectomy (defined as splenectomy within 6 hours of admission) in the management of BSI as well as the relationship between urgent splenectomy and in-hospital mortality.

Methods: The National Trauma Data Bank for 2007 was queried for adults (18–81) who suffered BSI. Patients who died in or were transferred from the emergency department were excluded. Hierarchical multivariate models were used to account for clustering of patients within hospitals and to identify hospital and patient factors associated with urgent splenectomy. Propensity score matching was used to analyze the relationship between urgent splenectomy and mortality.

Results: There were 507,202 total incidents identified. Of those, 11,793 met inclusion criteria. Urgent splenectomy was performed on 1,104 (9.4%). Hierarchical models revealed that age ≥55 years, arrival systolic blood pressure ≤90 mm Hg, no or mild head injury, increasing injury severity, and massive disruption of the spleen were associated with urgent splenectomy. Hospitals level factors associated with urgent splenectomy included hospital region, hospital type, and trauma center level. The propensity-matched cohorts revealed no association between urgent splenectomy and in-hospital mortality (odds ratio, 1.08; 95% confidence interval, 0.82–1.42).

Conclusion: Despite ongoing variation in the use of urgent splenectomy after BSI in adults, urgent splenectomy was not associated with in-hospital mortality.

From the Division of Trauma and Critical Care, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.

Submitted for publication January 31, 2011.

Accepted for publication May 17, 2011.

Address for reprints: Ben L. Zarzaur, MD, MPH, Department of Surgery, University of Tennessee Health Science Center, 910 Madison Building, 2nd Floor, Memphis, TN 38163; email: bzarzaur@uthsc.edu.

© 2011 Lippincott Williams & Wilkins, Inc.