Early mobilization of patients with non-operative liver and spleen injuries is safe and cost effective
There is no standard protocol for the management of non-operative liver or spleen injuries (LSI). In 2011, our institution changed the non-operative management (NOM) protocol of LSI from prolonged bed rest (PBR) to early mobilization (EM). We aim to show that EM safely decreases length of stay (LOS), ICU LOS, and cost.
We conducted a retrospective review in which non-operative LSI patients observed PBR from January 2008 through July 2011 and were mobilized early from August 2011 through December 2014. Endpoints assessed were length of bed rest, hospital LOS, ICU LOS, failure of NOM, cost, angiography/embolization, and mortality.
There were a total of 184 patients with LSI who met study criteria and were not excluded. 77 patients utilized PBR between 2008 and 2011 and 107 followed EM protocol between 2011 and 2014. There was no significant difference in the male to female ratio, age, ISS, anticoagulant use, or MOI. Both groups had similar injury profiles. PBR included 34 liver injuries, 45 splenic injuries and two patients with both. EM included 63 liver injuries, 55 splenic injuries and 11 patients with both (for liver injury p = 0.053, for splenic injury p = 0.37, and for combined p = 0.08). LOS and cost were significantly decreased in the EM cohort. LOS was shortened by 1.07 days (p = 0.005) and cost of hospitalization was reduced by $7077 (p = 0.046). There was no difference in NOM failure, angiography/embolization, or mortality.
EM in non-operative LSI is safe and cost-effective. It results in decreased LOS and cost without increasing failure of NOM, angiography, embolization, or mortality.
KeywordsComplication Spleen Liver Outcome assessment Traumatology
Dr. Teichman was involved in idea conception, data collection and analysis, manuscript creation and submission. Dr. Scantling was involved in data analysis, manuscript creation and submission. Dr. McCracken and Dr. Eakins were involved in project conception and manuscript drafting.
Compliance with ethical standards
Conflict of interest
Amanda Teichman, Dane Scantling, Brendan McCracken and James Eakins declare that they have no conflict of interest.
Amanda Teichman, Dane Scantling, Brendan McCracken, and James Eakins report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Research involving human participants/animals
Research involved human subjects and was of a retrospective nature.
Informed consent was unnecessary for this study as it was a retrospective review and all material was de-identified.
- 1.Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS) (online). (2005).Google Scholar
- 2.Xu JQ, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths. Final data for 2007. National vital statistics reports. Hyattsville: National Center for Health Statistics. http://www.cdc.gov/injury/wisqars2. 2010;58(19). Accessed Aug 2016
- 3.Centers for Disease Control and Prevention, National Center for Health Statistics (NCHS). National hospital discharge survey: 2007 summary. National health statistics reports, no. 29. Atlanta: NCHS; 2010.Google Scholar
- 7.Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ Jr, Sangosanya A, Schuster K, Seamon M, Tchorz KM, Zarzuar BL, Kerwin A. Eastern Association for the Surgery of Trauma. Selective nonoperative management of blunt hepatic injury: an Eastern Association for the Surgery of Trauma practice management guidelines. J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S288–293.Google Scholar
- 8.Stassen NA, Bhullar I, Cheng JD, Crandall ML, Friese RS, Guillamondegui OD, Jawa RS, Maung AA, Rohs TJ Jr, Sangosanya A, Schuster K, Seamon M, Tchorz KM, Zarzuar BL, Kerwin A. Eastern Association for the Surgery of Trauma. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guidelines. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S294–300.PubMedGoogle Scholar
- 19.Sclafani SJ, Shaftan GW, Scalea TM, Patterson LA, Kohl L, Kantor A, Herkowitz MM, Hoffer EK, Henry S, Dresner LS. Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma. 1995;39:818–27.CrossRefPubMedGoogle Scholar
- 21.Smith J, Armen S, Cook C, Martin L. Blunt splenic injuries: have we watched long enough?. J Trauma. 2008; 656–65.Google Scholar