N. Cho1, E. Aguayo1, N. Le1, D. Yalzadeh1, E. Elkins1, A. Tillou1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles, Surgery, Los Angeles, CA, USA
Introduction:
The use of Splenic Arterial Embolization (SAE) has become more prevalent in the treatment of blunt splenic injuries. However, there is a lack of data on the overall outcomes of SAE. Thus, we aimed to evaluate the clinical and financial outcomes of patients who underwent SAE for splenic injuries and required conversion to splenectomy.
Methods:
A retrospective cohort analysis was performed using the Nationwide Readmission Database for the period of 2016-2021. All adult patients (≥18 years) undergoing SAE or splenectomy for blunt splenic injuries at index hospitalization were included. Those who eventually required a conversion to splenectomy during their index stay or were readmitted for a splenectomy were grouped into a failed embolization (FE) cohort. All other SAE patients were considered non-FE. The institutional annual caseload of SAE was used to define high- and low-SAE volume tertile. Trauma Mortality Prediction Model (TMPM) was utilized to quantify the severity of injury. In-hospital mortality, length of stay (LOS), and hospitalization costs were analyzed as secondary outcomes. Multivariable regression models were used to evaluate the association between FE and the selected outcomes of interest.
Results:
During the study period, among 42,303 patients undergoing operative management for blunt spleen injury, 16,978 (40.1%) had SAE as the initial approach, and 1,487 (8.8%) had FE. The proportion of FE cases remained stable from 8.7% in 2016 to 9.2% in 2020 (nptrend=0.46). Compared to others, FE patients had a similar distribution of female sex (32.3 vs 32.1%, P=0.94) and severity of injury (33.5 [6.1-77.6] vs 38.0 [7.9-76.8], P=0.09). FE patients were older (49 [30-61] vs 45 [30-61] years, P<0.001) and had a lower median Elixhauser Comorbidity Index (1 [0-2] vs 2 [1-3], P<0.001). Compared to non-FE, a similar proportion of FE patients were managed at high SAE volume centers (38.0 vs 38.8%, P=0.19). After risk adjustment, management at high-SAE volume was associated with reduced odds of FE compared to management at low-SAE volume (Adjusted Odds Ratio [AOR] 0.28, 95% Confidence Interval [95%CI] 0.22-0.37) (FIGURE). Compared to others, FE status was associated with increased mortality (AOR 2.52, 95%CI 1.86-3.42) as well as longer index hospitalization LOS by 4.7 days (95% CI 4.0-5.5 days) and cost by $27,600 (95%CI 24,400-30,900).
Conclusion:
Our findings suggest that use of splenectomy after SAE has remained stable over time, and conversion is associated with increased odds of mortality and resource utilization. While SAE is a valuable treatment option, careful patient selection and monitoring are critical to optimize outcomes.