Predictors for Failure of Non-operative Management of Splenic Injuries

Abstract

Non-operative management of splenic injuries is the standard of treatment of splenic injuries in hemodynamically stable patients. The present study aimed to investigate the outcome of non-operative management versus surgical management of splenic injuries and to determine the predictors for failure of non-operative management in a setting where selective arterial embolization is not available. This was a case series analysis of patients with splenic injuries who were treated with non-operative management or surgical exploration. Multivariable logistic regression analysis was used to determine the predictors for failure of non-operative management. Ninety-one patients (78 men and 13 women) were included to this study. Forty (44%) patients were managed with non-operative management, and 51 (56%) were managed surgically. The mean hospital stay of the two groups was similar (p = 0.72). Failure of non-operative management was recorded in 14 (35%) patients. Complications related to splenic trauma were detected in 7 (17.5%) patients in the non-operative management group and 16 (31.4%) in the surgical treatment group (p = 0.2). Predictors for failure of non-operative management were age (p = 0.004), total leucocyte count (p = 0.0004), platelet count (p = 0.0002), and associated extra-abdominal injuries (p = 0.045). The only significant independent predictor for failure of non-operative management was associated extra-abdominal injuries (OR 4.4; p = 0.04). Non-operative management of splenic injuries is feasible and associated with favorable outcome. Age, total leucocyte count, platelet count, and extra-abdominal injuries may predict failure of non-operative management and warrant surgical intervention.