Abstract
Background
Splenectomies are widely performed, but there exists controversy regarding care for splenic injury patients. The purpose of this study is to provide a comprehensive review of the literature over the last 20 years for operative management (OM) versus nonoperative management (NOM) versus splenic artery embolization (SAE) for traumatic splenic injuries and associated outcomes.
Methods
A review of literature was performed following the PRISMA guidelines through a search of PubMed, EMBASE, Cochrane Library, JAMA Network, and SAGE journals from 2000 to 2020 regarding splenic injury in trauma patients and their management. Articles were then selected based on inclusion/exclusion criteria with GRADE criteria used on the included articles to assess quality.
Results
Twenty retrospective cohorts and one prospective cohort assessed patients who received OM versus NOM or SAE. Multiple studies indicated that NOM, in properly selected patients, provided better outcomes than its operative counterpart.
Conclusion
This review provides additional evidence to support the NOM of splenic injuries for hemodynamically stable patients with benign abdomens as it accounts for consistently shorter hospital length of stay, fewer complications, and lower mortality than OM. For hemodynamically unstable patients, management continues to be intervention with surgery. More studies are needed to further investigate outcomes of post-splenectomy patients based on grade of injury, hemodynamic status, type of procedure (i.e., SAE), and failure of NOM in order to provide additional evidence and improve outcomes for this patient population.
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Change history
26 September 2021
A Correction to this paper has been published: https://doi.org/10.1007/s00268-021-06323-w
References
Cirocchi R, Boselli C, Corsi A et al (2013) Is non-operative management safe and effective for all splenic blunt trauma? A systematic review. Crit Care 17(5):R185
Zarzaur BL, Rozycki GS (2017) An update on nonoperative management of the spleen in adults. Trauma Surg Acute Care Open 2(1):e000075
Skattum J, Naess PA, Gaarder C (2012) Non-operative management and immune function after splenic injury. Br J Surg 99(Suppl 1):59–65
Scarborough JE, Ingraham AM, Liepert AE et al (2016) Nonoperative management is as effective as immediate splenectomy for adult patients with high-grade blunt splenic injury. J Am Coll Surg 223(2):249–258
Teuben M, Spijkerman R, Teuber H et al (2020) Splenic injury severity, not admission hemodynamics, predicts need for surgery in pediatric blunt splenic trauma. Patient Saf Surg 14:1
Saurabh G, Kumar S, Gupta A et al (2011) Splenic trauma - our experience at a level I Trauma Center. Ulus Travma Acil Cerrahi Derg 17(3):238–242
Heuer M, Taeger G, Kaiser GM et al (2010) No further incidence of sepsis after splenectomy for severe trauma: a multi-institutional experience of the trauma registry of the DGU with 1,630 patients. Eur J Med Res 15(6):258–265
Cadeddu M, Garnett A, Al-Anezi K et al (2006) Management of spleen injuries in the adult trauma population: a ten-year experience. Can J Surg 49(6):386–390
Jesani H, Jesani L, Rangaraj A et al (2020) Splenic trauma, the way forward in reducing splenectomy: our 15-year experience. Ann R Coll Surg Engl 102(4):263–270
Bagaria D, Kumar A, Ratan A et al (2019) Changing aspects in the management of splenic injury patients: experience of 129 isolated splenic injury patients at level 1 trauma center from India. J Emerg Trauma Shock 12(1):35–39
Spijkerman R, Teuben MPJ, Hoosain F et al (2017) Non-operative management for penetrating splenic trauma: how far can we go to save splenic function? World J Emerg Surg 12:33
Zurita Saavedra M, Pérez Alonso A, Pérez Cabrera B et al (2020) Management of splenic injuries utilizing a multidisciplinary protocol in 110 consecutive patients at a level II hospital. Cir Esp 98(3):143–148
Bruce PJ, Helmer SD, Harrison PB et al (2011) Nonsurgical management of blunt splenic injury: is it cost effective? Am J Surg 202(6):810–816
Duchesne JC, Simmons JD, Schmieg RE Jr et al (2008) Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis. J Trauma 65(6):1346–1353
Wei B, Hemmila MR, Arbabi S et al (2008) Angioembolization reduces operative intervention for blunt splenic injury. J Trauma 64(6):1472–1477
Guinto R, Greenberg P, Ahmed N (2020) Emergency management of blunt splenic injury in hypotensive patients: total splenectomy versus splenic angioembolization. Am Surg 86(6):690–694
Aiolfi A, Inaba K, Strumwasser A et al (2017) Splenic artery embolization versus splenectomy: analysis for early in-hospital infectious complications and outcomes. J Trauma Acute Care Surg 83(3):356–360
Frandon J, Rodiere M, Arvieux C et al (2015) Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery? Diagn Interv Radiol 21(4):327–333
Chastang L, Bège T, Prudhomme M et al (2015) Is non-operative management of severe blunt splenic injury safer than embolization or surgery? Results from a French prospective multicenter study. J Visc Surg 152(2):85–91
Rosati C, Ata A, Siskin GP et al (2015) Management of splenic trauma: a single institution’s 8-year experience. Am J Surg 209(2):308–314
Smith HE, Biffl WL, Majercik SD et al (2006) Splenic artery embolization: Have we gone too far? J Trauma 61(3):541–546
Wahl WL, Ahrns KS, Chen S et al (2004) Blunt splenic injury: operation versus angiographic embolization. Surgery 136(4):891–899
Gross JL, Woll NL, Hanson CA et al (2013) Embolization for pediatric blunt splenic injury is an alternative to splenectomy when observation fails. J Trauma Acute Care Surg 75(3):421–425
Rajani RR, Claridge JA, Yowler CJ et al (2006) Improved outcome of adult blunt splenic injury: a cohort analysis. Surgery 140(4):625–632
Beuran M, Gheju I, Venter MD et al (2012) Non-operative management of splenic trauma. J Med Life 5(1):47–58
Van der Cruyssen F, Manzelli A (2016) Splenic artery embolization: technically feasible but not necessarily advantageous. World J Emerg Surg 11(1):47
Nijdam TMP, Spijkerman R, Hesselink L et al (2020) Predictors of surgical management of high grade blunt splenic injuries in adult trauma patients: a 5-year retrospective cohort study from an academic level I trauma center. Patient Saf Surg 14:32
Stassen NA, Bhullar I, Cheng JD et al (2012) Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73(5 Suppl 4):S294–S300
Rowell SE, Biffl WL, Brasel K et al (2017) Western trauma association critical decisions in trauma: management of adult blunt splenic trauma-2016 updates. J Trauma Acute Care Surg 82(4):787–793
Coccolini F, Montori G, Catena F et al (2017) Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 12:40
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AE contributed to study design and conception. SG, JH, AM, AE, CS, and MM contributed to data collection, analysis, and interpretation. SG, JH, CS, AM, MM, and AE contributed to manuscript preparation. SG, AE, MM, JH, AM, and CS contributed to critical revisions of manuscript. All authors approved the final version of manuscript.
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Gill, S., Hoff, J., Mila, A. et al. Post-traumatic Splenic Injury Outcomes for Nonoperative and Operative Management: A Systematic Review. World J Surg 45, 2027–2036 (2021). https://doi.org/10.1007/s00268-021-06063-x
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DOI: https://doi.org/10.1007/s00268-021-06063-x