T. Bongiovanni1, A. Stey1, A. Conroy1, C. Wybourn1, R. A. Callcut1 1University Of California – San Francisco,Zuckerberg San Francisco General Hospital, Department Of Surgery, General And Trauma Surgery,San Francisco, CA, USA
Introduction: In 2003, national guidelines were first published recommending potential benefit to non-operative management for hemodynamically stable patients suffering splenic injury. In 2012, updated guidelines supported extension of non-operative therapy to higher-grade injuries and older patients in the presence of hemodynamic stability. This study investigates the adoption of non-operative therapy by examining national trends and associated outcomes.
Methods: The National Trauma Data Bank National Sample Program weighted file was used to conduct an observational and serial cross-sectional cohort study between January 1, 2008 and December 31, 2012, identifying hospitalizations during which a patient greater than 12 years old was diagnosed with a traumatic splenic injury.
Results: Among the almost 3.5 million unique patients in the database, there were 47,212 splenic injuries documented from the years 2008-2012 (69% men, mean [SD] 37.8 [18.1] years) for traumatic splenic injury, of which 9,961 (21%) underwent operative intervention.
Interestingly, there was as overall decrease in reporting of splenic injuries by 2011 and 2012, though there was no change in OR use (210 per 1000 injuries in 2008 vs 220 per 1000 injuries in 2012). Over the 5 year study period, there was no improvement in the mean length of stay (11.5 days in 2008, 11.0 days in 2012) or in the number of ICU days (4.81 days in 2008, 5.13 days in 2012). However, the rates of transfusion have increased dramatically from 2008 to 2012 (FFP transfusion 3.0% to 8.2%, p<0.001, platelet transfusion 1.4% to 4.8%, p<0.001, pRBC 9.3% to 18.7%, p<0.001).
In multivariate regression, controlling for age, injury severity score, GCS upon arrival, transfusions of FFP, platelets, prbcs, race, and tachycardia or hypotension in the emergency department, there was no significant difference in survival among each year of analysis.
Conclusion: Within 5 years of the initial recommendations for non-operative therapy, the rate of surgical intervention had plateaued and remained stable in the subsequent years 2008-2012. However, the rate of transfusion has continued to climb suggesting that patient exposure to blood products has increased while attempting splenic preservation. Further investigation should be done to better elucidate the reasons for increased transfusions requirement, and possible delayed care in these patients.