Splenectomy versus angioembolization for severe splenic injuries in a national trauma registry: To save, or not to save, the spleen, that is the question

Terry R Schaid Jr; Ernest E Moore; Renaldo Williams; Angela Sauaia; Isabella M Bernhardt; Fredrick M Pieracci; Daniel D Yeh

doi:10.1016/j.surg.2024.109058

Splenectomy versus angioembolization for severe splenic injuries in a national trauma registry: To save, or not to save, the spleen, that is the question

Surgery. 2025 Jan 4:180:109058. doi: 10.1016/j.surg.2024.109058. Online ahead of print.

Authors

Terry R Schaid Jr¹, Ernest E Moore², Renaldo Williams², Angela Sauaia³, Isabella M Bernhardt⁴, Fredrick M Pieracci², Daniel D Yeh⁵

Affiliations

¹ Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO.
² Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, CO.
³ Sauaia Statistical Solutions, L.L.C., Denver, CO.
⁴ Department of Biological Sciences, Hunter College, City University of New York, New York, NY.
⁵ Department of Surgery, University of Colorado Denver School of Medicine, Aurora, CO; Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, CO. Electronic address: dante.yeh@dhha.org.

PMID: 39756336
DOI: 10.1016/j.surg.2024.109058

Abstract

Background: The use of angioembolization as a first approach for treating severe, blunt splenic injuries has increased recently, yet evidence showing its superiority to immediate splenectomy is lacking. We compared the prognosis of angioembolization versus splenectomy in patients presenting hemodynamically unstable with high-grade, image-confirmed, blunt splenic injuries in a nationally representative dataset.

Methods: We queried the 2017-2022 Trauma Quality Improvement Program database for adults with blunt splenic injury abbreviated injury scale = 4-5, with arrival systolic blood pressure <90 mm Hg, and treated with either angioembolization or splenectomy <6 hours of arrival after a computed tomography scan. Entropy balancing was used to adjust for confounders.

Results: Of 1,360 patients, 328 (24.1%) underwent angioembolization and 1,032 (75.9%) splenectomy. Treatment with angioembolization first was more likely in recent years, in level 1 trauma centers, for less severe spleen injuries, in the absence of head injuries. Angioembolization and splenectomy had similar entropy balancing-adjusted survival (entropy balancing hazard ratio = 1.02; 95% confidence interval: 0.97-1.07, P = .49). One-fifth of those with angioembolization first required rescue splenectomy <6 hours, mostly those with spleen injury grade 5 and additional abdominal injuries. Although this resulted in worse survival (hazard ratio: 1.12; 95% confidence Interval: 0.99-1.26) than successful angioembolization, the survival was not significantly worse than those treated with splenectomy first (entropy balancing hazard ratio: 1.07; 95% confidence Interval: 0.96-1.20).

Conclusion: Angioembolization was associated with similar survival to splenectomy first for patients arriving hypotensive with severe, image-confirmed blunt splenic injuries, suggesting that it was an appropriate treatment decision. Although survival was worse after failed angioembolization than after successful angioembolization, it was not worse than splenectomy first, suggesting that the attempt to preserve the spleen was justified.