R.B. Gelbard1, R.L. Griffin1, A.B. Sturdivant1, D.T. Lammers1, S.D. Goddard1, J.O. Jansen1, Z.G. Hashmi1 1University Of Alabama at Birmingham, Surgery, Birmingham, Alabama, USA
Introduction:
For trauma patients with post-splenectomy leukocytosis, platelet-to-white blood cell ratio (PWR)<20 on post-operative day 5 is associated with infection. However, it remains unclear whether this relationship also holds true among patients undergoing splenic angioembolization. We sought to characterize platelet and WBC count trajectories after splenectomy (SPLEN) or splenic angioembolization (EMBO) to assess the association between PWR and post-procedure infection.
Methods:
Patients with hospital stays longer than 4 days that underwent SPLEN or EMBO for splenic injury were identified from the institutional trauma registry between 2018-2022. Daily PWR was collected from electronic health records for both cohorts. The PWR on post-procedure day 5 was analyzed using a multivariable regression analysis adjusted for age, sex, ISS and abdominal AIS 2+. The primary outcome of interest was post-procedure infection (defined as intra-abdominal abscess requiring drainage or positive blood, urine, bronchoalveolar lavage, or fungal culture).
Results:
A total of 363 patients underwent EMBO (n=157, 43.2%) or SPLEN (n=206, 56.8%). Overall post-procedure infection rate was 15%. PWR was significantly lower in infected SPLEN patients compared to non-infected SPLEN patients by post-procedure day 3 (p<0.05). There was no statistical difference in PWR for any post-procedure day for the EMBO cohort (Figure). PWR<20 on post-procedure day 5 was significantly associated with infection for the SPLEN cohort (OR 2.70; 95% CI 1.25-5.84), but not the EMBO cohort (OR 1.02; 95% CI 0.27-3.77).
Conclusion:
The current study corroborates the association between post-procedure day 5 PWR<20 and infection following splenectomy; however, the same association was not observed after embolization.