Variation in the use of urgent splenectomy after blunt splenic injury in adults

Ben L. Zarzaur, Martin Croce, Timothy Fabian

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: Recent reports indicate that mortality after trauma center admission may be directly related to the rate of operative intervention after blunt solid organ injury. These findings bring into question the role of urgent splenectomy after blunt splenic injury (BSI). The purpose of this study was to determine the role of urgent splenectomy (defined as splenectomy within 6 hours of admission) in the management of BSI as well as the relationship between urgent splenectomy and in-hospital mortality. Methods: The National Trauma Data Bank for 2007 was queried for adults (18-81) who suffered BSI. Patients who died in or were transferred from the emergency department were excluded. Hierarchical multivariate models were used to account for clustering of patients within hospitals and to identify hospital and patient factors associated with urgent splenectomy. Propensity score matching was used to analyze the relationship between urgent splenectomy and mortality. Results: There were 507,202 total incidents identified. Of those, 11,793 met inclusion criteria. Urgent splenectomy was performed on 1,104 (9.4%). Hierarchical models revealed that age ≤55 years, arrival systolic blood pressure ≤90 mm Hg, no or mild head injury, increasing injury severity, and massive disruption of the spleen were associated with urgent splenectomy. Hospitals level factors associated with urgent splenectomy included hospital region, hospital type, and trauma center level. The propensity-matched cohorts revealed no association between urgent splenectomy and in-hospital mortality (odds ratio, 1.08; 95% confidence interval, 0.82-1.42). Conclusion: Despite ongoing variation in the use of urgent splenectomy after BSI in adults, urgent splenectomy was not associated with in-hospital mortality.

Original languageEnglish (US)
Pages (from-to)1333-1339
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number5
DOIs
StatePublished - Nov 1 2011

Fingerprint

Nonpenetrating Wounds
Splenectomy
Hospital Mortality
Trauma Centers
Wounds and Injuries
Blood Pressure
Propensity Score
Mortality
Craniocerebral Trauma
Cluster Analysis
Hospital Emergency Service
Spleen
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Variation in the use of urgent splenectomy after blunt splenic injury in adults. / Zarzaur, Ben L.; Croce, Martin; Fabian, Timothy.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. 5, 01.11.2011, p. 1333-1339.

Research output: Contribution to journalArticle

@article{4a87c13724ae41de9db64f6ad9b58ee0,
title = "Variation in the use of urgent splenectomy after blunt splenic injury in adults",
abstract = "Objective: Recent reports indicate that mortality after trauma center admission may be directly related to the rate of operative intervention after blunt solid organ injury. These findings bring into question the role of urgent splenectomy after blunt splenic injury (BSI). The purpose of this study was to determine the role of urgent splenectomy (defined as splenectomy within 6 hours of admission) in the management of BSI as well as the relationship between urgent splenectomy and in-hospital mortality. Methods: The National Trauma Data Bank for 2007 was queried for adults (18-81) who suffered BSI. Patients who died in or were transferred from the emergency department were excluded. Hierarchical multivariate models were used to account for clustering of patients within hospitals and to identify hospital and patient factors associated with urgent splenectomy. Propensity score matching was used to analyze the relationship between urgent splenectomy and mortality. Results: There were 507,202 total incidents identified. Of those, 11,793 met inclusion criteria. Urgent splenectomy was performed on 1,104 (9.4{\%}). Hierarchical models revealed that age ≤55 years, arrival systolic blood pressure ≤90 mm Hg, no or mild head injury, increasing injury severity, and massive disruption of the spleen were associated with urgent splenectomy. Hospitals level factors associated with urgent splenectomy included hospital region, hospital type, and trauma center level. The propensity-matched cohorts revealed no association between urgent splenectomy and in-hospital mortality (odds ratio, 1.08; 95{\%} confidence interval, 0.82-1.42). Conclusion: Despite ongoing variation in the use of urgent splenectomy after BSI in adults, urgent splenectomy was not associated with in-hospital mortality.",
author = "Zarzaur, {Ben L.} and Martin Croce and Timothy Fabian",
year = "2011",
month = "11",
day = "1",
doi = "10.1097/TA.0b013e318224d0e4",
language = "English (US)",
volume = "71",
pages = "1333--1339",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Variation in the use of urgent splenectomy after blunt splenic injury in adults

AU - Zarzaur, Ben L.

AU - Croce, Martin

AU - Fabian, Timothy

PY - 2011/11/1

Y1 - 2011/11/1

N2 - Objective: Recent reports indicate that mortality after trauma center admission may be directly related to the rate of operative intervention after blunt solid organ injury. These findings bring into question the role of urgent splenectomy after blunt splenic injury (BSI). The purpose of this study was to determine the role of urgent splenectomy (defined as splenectomy within 6 hours of admission) in the management of BSI as well as the relationship between urgent splenectomy and in-hospital mortality. Methods: The National Trauma Data Bank for 2007 was queried for adults (18-81) who suffered BSI. Patients who died in or were transferred from the emergency department were excluded. Hierarchical multivariate models were used to account for clustering of patients within hospitals and to identify hospital and patient factors associated with urgent splenectomy. Propensity score matching was used to analyze the relationship between urgent splenectomy and mortality. Results: There were 507,202 total incidents identified. Of those, 11,793 met inclusion criteria. Urgent splenectomy was performed on 1,104 (9.4%). Hierarchical models revealed that age ≤55 years, arrival systolic blood pressure ≤90 mm Hg, no or mild head injury, increasing injury severity, and massive disruption of the spleen were associated with urgent splenectomy. Hospitals level factors associated with urgent splenectomy included hospital region, hospital type, and trauma center level. The propensity-matched cohorts revealed no association between urgent splenectomy and in-hospital mortality (odds ratio, 1.08; 95% confidence interval, 0.82-1.42). Conclusion: Despite ongoing variation in the use of urgent splenectomy after BSI in adults, urgent splenectomy was not associated with in-hospital mortality.

AB - Objective: Recent reports indicate that mortality after trauma center admission may be directly related to the rate of operative intervention after blunt solid organ injury. These findings bring into question the role of urgent splenectomy after blunt splenic injury (BSI). The purpose of this study was to determine the role of urgent splenectomy (defined as splenectomy within 6 hours of admission) in the management of BSI as well as the relationship between urgent splenectomy and in-hospital mortality. Methods: The National Trauma Data Bank for 2007 was queried for adults (18-81) who suffered BSI. Patients who died in or were transferred from the emergency department were excluded. Hierarchical multivariate models were used to account for clustering of patients within hospitals and to identify hospital and patient factors associated with urgent splenectomy. Propensity score matching was used to analyze the relationship between urgent splenectomy and mortality. Results: There were 507,202 total incidents identified. Of those, 11,793 met inclusion criteria. Urgent splenectomy was performed on 1,104 (9.4%). Hierarchical models revealed that age ≤55 years, arrival systolic blood pressure ≤90 mm Hg, no or mild head injury, increasing injury severity, and massive disruption of the spleen were associated with urgent splenectomy. Hospitals level factors associated with urgent splenectomy included hospital region, hospital type, and trauma center level. The propensity-matched cohorts revealed no association between urgent splenectomy and in-hospital mortality (odds ratio, 1.08; 95% confidence interval, 0.82-1.42). Conclusion: Despite ongoing variation in the use of urgent splenectomy after BSI in adults, urgent splenectomy was not associated with in-hospital mortality.

UR - http://www.scopus.com/inward/record.url?scp=81455131684&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=81455131684&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e318224d0e4

DO - 10.1097/TA.0b013e318224d0e4

M3 - Article

VL - 71

SP - 1333

EP - 1339

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -