Splenic preservation after isolated splenic blunt trauma: The angioembolization paradox
| Autor: | Jared R. Gallaher, Anthony G. Charles, Trista Reid, Lauren Raff, Andrew B. Schneider, Laura N. Purcell |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Splenectomy 030230 surgery Splenic artery Wounds Nonpenetrating Blunt splenic trauma Young Adult 03 medical and health sciences 0302 clinical medicine Blunt medicine.artery Humans Medicine Retrospective Studies business.industry Patient Selection Middle Aged medicine.disease Embolization Therapeutic United States Surgery Logistic Models Treatment Outcome Abdominal trauma Blunt trauma 030220 oncology & carcinogenesis Relative risk Injury Severity Score Female business Spleen |
| Zdroj: | Surgery. 170:628-633 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2021.01.007 |
| Popis: | Background The spleen is the most commonly injured organ in blunt abdominal trauma. The management for splenic trauma includes nonoperative management, splenectomy, and splenic artery angioembolization. The aim of this study is to investigate recent trends in the usage of splenic artery angioembolization in patients with isolated blunt splenic trauma. Methods Adult patients (age >15) with isolated blunt splenic trauma were identified from the National Trauma Databank (2007–2015) using International Classification of Diseases, Ninth Revision, codes. The defined groups included nonoperative management, splenectomy, and splenic artery angioembolization. Patient variables collected included year of traumatic injury, age, sex, race, insurance status, and geographic region. Clinical variables collected included vital signs (systolic blood pressure, pulse, respiratory rate) recorded upon arrival to the emergency room, injury severity score, abbreviated injury severity scores, diagnoses, procedures, and mechanism. Outcome measures included mortality, hospital duration of stay, and complications. We performed 2 independent Poisson logistic regression models to assess relative risk for both splenectomy and angioembolization. Results A total of 10,812 patients were included in the analysis (nonoperative management: 7,920; splenectomy: 2,083; angioembolization: 809). Angioembolization proportion increased from 2007 (4.6%) to 2015 (10%), while splenectomy proportion remained unchanged (19.2% to 18.3%). Poisson logistic regression suggests the adjusted probability of receiving angioembolization for a splenic injury increased year-to-year, while the adjusted probability of receiving a splenectomy remained unchanged. Conclusion The use of angioembolization for isolated blunt splenic injuries has increased over the past decade without a reciprocal change in splenectomy. Based on this study, angioembolization may be an overused resource without a significant benefit. |
| Databáze: | OpenAIRE |
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