R. A. Rasheed1, E. A. Rogers-Delmas1, A. H. Tyroch1, B. R. Davis1 1Texas Tech University Health Sciences Center In El Paso,Department Of Surgery,El Paso, TX, USA
Introduction:
The purpose of this paper is to analyze the effect of cirrhosis on morbidity and mortality incurred by patients that have sustained splenic injuries due to non-penetrating abdominal trauma.
Methods:
CPT codes for “cirrhosis” and “injury to spleen” were submitted to the UMC Trauma Data Bank as search criteria for patient selection. The period of evaluation spanned from January 01 2009 to August 31 2014. Over this period of time, 266 patients suffered splenic trauma. Multiple points of demographic data were obtained, the most important of which was grade of splenic injury and procedures undergone during hospitalization.
Of these 266 patients, 11 patients carried a diagnosis of cirrhosis due to any etiology. Once this pool of patients was obtained, we used laboratory parameters to calculate a MELD score for each patient. We then searched for evidence of non-operative management and subsequent conversion to procedural management, which was either indicated by the presence of an operative report for laparotomy and splenectomy, or a procedure report for splenic artery embolization.
We then analyzed the data, and attempted to sort patients into subsets of splenic injury grading and determine the threshold MELD that predicted the need for operative management.
Results:
In patients with Grade I & II splenic injury, MELD did not seem to predict failure of non-operative management. In patients with Grade III splenic injury, a MELD > 18 predicted failure of non-operative management. In patients with Grade IV injury, failure of non-operative management occurred, regardless of MELD.
Conclusion:
This correlative data could be used to predict failure rates of non-operative management, and may allow surgeons to better prepare for operative management in this subset of challenging trauma patients.
Due to the limited data, the power of this analysis is limited. However, this limited series does seem to suggest that greater severity of cirrhosis portends a higher failure rate of non-operative management in the setting of blunt splenic injury. This is consistent with the findings of larger studies that demonstrate cirrhosis is an independent risk factor for failure of non-operative management in this unique subset of trauma patients. The published literature will be reviewed during the course of the presentation. Further plans for this study include pooling data from other trauma centers in the state in an attempt to power the study and reach statistical significance.
