Clinical factors and outcomes of spleen-conserving surgery versus total splenectomy in splenic injuries: A nationwide database study.

Autor: Tang-Tan A; Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA. Electronic address: tangtan@usc.edu., Chien CY; Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd, Anle District, Keelung City, 204, Taiwan. Electronic address: hjjiimm@hotmail.com., Park S; Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA. Electronic address: Stephen.park@med.usc.edu., Schellenberg M; Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA. Electronic address: morgan.schellenberg@med.usc.edu., Lam L; Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA. Electronic address: Lydia.lam@med.usc.edu., Martin M; Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA. Electronic address: matthew.martin@med.usc.edu., Inaba K; Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA. Electronic address: kenji.inaba@med.usc.edu., Matsushima K; Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA. Electronic address: kazuhide.matsushima@med.usc.edu.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2024 Jul; Vol. 233, pp. 142-147. Date of Electronic Publication: 2024 Mar 08.
DOI: 10.1016/j.amjsurg.2024.03.010
Abstrakt: Background: The objective of this study was to identify factors associated with the use of spleen-conserving surgeries, as well as patient outcomes, on a national scale.
Methods: This retrospective cohort study (2010-2015) included patients (age≥16 years) with splenic injury in the National Trauma Data Bank. Patients who received a total splenectomy or a spleen-conserving surgery were compared for demographics and clinical outcomes.
Results: During the study period, 18,425 received a total splenectomy and 1,825 received a spleen-conserving surgery. Total splenectomy was more likely to be performed for patients with age>65 (odds ratio [OR]: 0.63, p ​< ​0.001), systolic blood pressure<90 (OR: 0.63, p ​< ​0.001), heart rate>120 (OR: 0.83, p ​= ​0.007), and high-grade injuries (OR: 0.18, p ​< ​0.001). Penetrating trauma patients were more likely to undergo a spleen-conserving surgery (OR: 3.31, p ​< ​0.001). The use of spleen-conserving surgery was associated with a lower risk of pneumonia (OR: 0.79, p ​= ​0.009) and venous thromboembolism (OR: 0.72, p ​= ​0.006).
Conclusions: Spleen-conserving surgeries may be considered for patients with penetrating trauma, age<65, hemodynamic stability, and low-grade injuries. Spleen-conserving surgeries have decreased risk of pneumonia and venous thromboembolism.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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