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Angioembolization for Isolated Severe Blunt Splenic Injuries with Hemodynamic Instability: A Propensity Score Matched Analysis

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Abstract

Background

This study aimed to compare patient outcomes after splenic angioembolization (SAE) or splenectomy for isolated severe blunt splenic injury (BSI) with hemodynamic instability, and to identify potential candidates for SAE.

Methods

Adult patients with isolated severe BSI (Abbreviated Injury Scale [AIS] 3–5) and hemodynamic instability between 2013 and 2019 were identified from the American College of Surgeons Trauma Quality Improvement (ACS TQIP) database. Hemodynamic instability was defined as an initial systolic blood pressure (SBP) <90 mmHg, heart rate (HR) >120 bpm, or lowest SBP <90 mmHg within 1 h after admission, with ≥1 unit of blood transfused within 4 h after admission. In-hospital mortality was compared between splenectomy and SAE groups using 2:1 propensity-score matching. The characteristics of unmatched and matched splenectomy patients were also compared.

Results

A total of 478 patients met our inclusion criteria (332 splenectomy, 146 SAE). After propensity-score matching, 166 splenectomy and 83 SAE patients were compared. Approximately 85% of propensity-score matched patients sustained AIS 3/4 injuries, and 50% presented with normal SBP and HR before becoming hemodynamically unstable. The median time to intervention (splenectomy or SAE) was 137 min (interquartile range 94–183). In-hospital mortality between splenectomy and SAE groups was not significantly different (5.4% vs. 4.8%, p = 1.000). More than half of unmatched patients in the splenectomy group sustained AIS 5 injuries and presented with initially unstable hemodynamics. The median time to splenectomy in such patients was significantly shorter than in matched splenectomy patients (67 vs. 132 min, p < 0.001).

Conclusion

Splenectomy remains the mainstay of treatment for patients with AIS 5 BSI who present to hospital with hemodynamic instability. However, SAE might be a feasible alternative for patients with AIS 3/4 injuries.

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Funding

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Authors and Affiliations

  1. Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, 371-0811, Japan

    Makoto Aoki

  2. Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan

    Shokei Matsumoto

  3. Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan

    Toshikazu Abe

  4. Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan

    Toshikazu Abe

  5. Department of Surgery, University of Wisconsin, Madison, WI, USA

    Ben L. Zarzaur

  6. Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA

    Kazuhide Matsushima

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  1. Makoto Aoki
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  2. Shokei Matsumoto
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  3. Toshikazu Abe
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  4. Ben L. Zarzaur
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  5. Kazuhide Matsushima
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Correspondence to Makoto Aoki.

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The authors declare no conflicts of interest.

Ethical approval

This study was approved by the institutional review board of the Japan Red Cross Maebashi Hospital. Because of the anonymous and retrospective nature of the study, the need for informed consent was waived.

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Aoki, M., Matsumoto, S., Abe, T. et al. Angioembolization for Isolated Severe Blunt Splenic Injuries with Hemodynamic Instability: A Propensity Score Matched Analysis. World J Surg 47, 2644–2650 (2023). https://doi.org/10.1007/s00268-023-07156-5

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  • DOI: https://doi.org/10.1007/s00268-023-07156-5

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