Is strict adherence to the nonoperative management protocol associated with better outcome in patients with blunt splenic injuries?: A retrospective comparative cross-sectional study. (September 2019)

• Record Type: Journal Article
• Authors: Hsieh, Ting-Min; Liu, Chun-Ting; Wu, Bei-Yu; Hsieh, Ching-Hua
• Is Part Of: International journal of surgery. Volume 69(2019)
• Page Start: 116
• Page End: 123
• Publication Date: 2019-09
• Subjects: Blunt splenic injuries -- Nonoperative management (NOM) -- Complications -- Morbidity -- Mortality; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2019.07.033
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: The nonoperative management (NOM) protocol with angioembolization (AE) presents a trend in dealing with trauma patients with blunt splenic injury (BSI). This study was designed to explore the adverse events and associated risk factors before and after protocol-based NOM of BSI over a 12-year period. Methods: A retrospective study was performed on adult trauma patients with BSI who were admitted from 2005 to 2016. The patients were divided into before cohort (2005–2010) and after cohort (2011–2016). Multivariate logistic regression analysis was performed to identify risk factors associated with the morbidity. The primary outcomes are NOM-related mortality and total number of complications, the secondary outcome is the incidence of each complication. Results: The before cohort was composed of 209 patients, and the after cohort had 190 patients. There was a significant increase in the use of AE (from 18.1% to 47.5%, p < 0.001) with a higher incidence of patients who had a shock episode before AE (from 4.2% to 16.5%, p < 0.001). Regarding the outcomes, there were no significant differences in the incidences of NOM-related mortality between the after than before cohorts. However, there were 190 complications in 71 patients in the before cohort but 289 complications in 73 patients in the after cohort. The incidence of complications was significantly higher in the group of after cohort than the group of before cohort. Regarding the complications, the patients in the after cohort were significantly more likely to have adverse events of coagulopathy, acidosis, hyperbilirubinemia, respiratory failure, and acute kidney injury than those in the before cohort. Conclusion: Strict adherence to the NOM protocol in treating patients with BSI without adequate patient selection increased not only the use of NOM but also the possibility of complications and failed to significantly improve the clinical outcomes. Highlights: Increased nonoperative management (NOM) for blunt splenic injury (BSI) was found. No significant differences of spleen- or NOM-related mortality after protocol implementation. Strictly-adhered NOM protocol in BSI did not lead to a better outcome. The complications are even possibly higher without adequate patient selection for NOM.