BACKGROUND: The spleen is one of the most frequently injured organs in abdominal trauma and is often managed nonoperatively with low rates of failure. A common adjunct to nonoperative management (NOM) is splenic artery embolization (SAE) which is controversial in some patient groups. We hypothesized that SAE would confer no benefit in elderly trauma patients undergoing NOM.
METHODS: This retrospective cohort study included patients in years 2019 to 2022 of the Trauma Quality Improvement Program database presenting after splenic trauma stratified into adult (age, 15-64 years) and elderly (age ≥ 65 years) cohorts. A cox proportional hazards model was used to estimate the adjusted odds of in-hospital mortality, up to 30 days, associated with age and management strategy. An interaction term between age group and management strategy allowed for evaluation of differential associations between cohorts. Secondary analysis focused on identification of predictors of NOM failure and potential differences between the age cohorts examined.
RESULTS: This study analyzed 65,421 adult and 11,813 elderly patients with splenic trauma. Age was a significant predictor of mortality with elderly patients having over triple the risk of mortality compared with adults; following age, SAE increased the mortality risk by 41%. Despite increasing overall mortality risk, in adults, SAE was protective against failure of NOM. This relationship was not seen in the elderly cohort, where SAE had no benefit for preventing failure of NOM.
CONCLUSION: Splenic artery embolization was associated with an increased risk of mortality in both adult and elderly patients and, as such, may be a marker for a decompensating patient. In the adult patient, SAE was beneficial for avoiding operative intervention. However, in the elderly patient no such benefit was seen. We recommend that in the decompensating elderly patient after splenic trauma, trauma surgeons should consider operative intervention, rather than SAE, as second-line therapy.
LEVEL OF EVIDENCE: Prognostic/Epidemiological; Level III.