Evolution, not revolution: splenic salvage for blunt trauma in a statewide voluntary trauma system—a 10-year experience

Bjerke, Scott; Pohlman, Timothy H.; Saywell, Robert M.; Przybylski, M.; Rodman, George H.

doi:10.1016/j.amjsurg.2005.10.046

Cited by 9 publications

(8 citation statements)

References 13 publications

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“…Non-operative management of blunt splenic injuries has replaced splenorrhaphy as the most common method of splenic conservation 8. The criteria have been extended to include patients previously excluded from this form of therapy.…”

Section: Discussionmentioning

confidence: 99%

Non-operative management in blunt splenic trauma

Notash

Amoli

Nikandish

et al. 2008

Emergency Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Non-operative management in blunt splenic trauma

Notash

Amoli

Nikandish

et al. 2008

Emergency Medicine Journal

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“…1,2,9 Several authors have noted the decreasing incidence of splenectomy for trauma over time associated with the evolving trend toward nonoperative splenic injury management. 2,[5][6][7] The medical indications for splenectomy have likewise evolved over time 3,8 and although several well-established medical indications for splenectomy exist, 10 the list is relatively short. We were therefore interested in evaluating the communitywide experience with splenectomy in the face of these rapidly evolving forces.…”

Section: Discussionmentioning

confidence: 99%

“…1,3 Improvements in the diagnosis and nonsurgical management of medical diseases for which splenectomy has formerly been performed have coincided with a better understanding of the immunological consequences of splenectomy and the increasing acceptance of nonoperative management of splenic trauma. 2,[4][5][6][7] These factors have all converged to suggest that elective as well as emergency splenectomy is becoming an increasingly less common operation. 8 The reports cited here document a decrease in the number of splenectomies, but reflect single-institution experiences with nontrauma splenectomies or regional experiences with splenectomy for trauma.…”

mentioning

confidence: 99%

“…8 The reports cited here document a decrease in the number of splenectomies, but reflect single-institution experiences with nontrauma splenectomies or regional experiences with splenectomy for trauma. 3,[5][6][7][8] None of these prior reports has assessed a communitywide or regional experience for all indications of splenectomy. We were interested in evaluating if these singleinstitution, tertiary medical center experiences with splenectomy are reflective of a broad, communitybased experience that includes both academic trauma centers and nonacademic medical centers.…”

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confidence: 99%

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Is Splenectomy after Trauma an Endangered Species?

Franklin

Miller

Richardson

2008

The American Surgeon

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Nonoperative management of splenic trauma is now the most common treatment modality for splenic injuries and splenectomy has almost disappeared in some trauma centers. Splenectomy for cancer staging is infrequently performed suggesting that the indications for splenectomy continue to evolve. We evaluated a state database to assess a communitywide experience with splenic surgery. International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes were used to determine the indication for splenic surgery. Indications for splenic surgery were listed as trauma (injury codes), medical (hematological diseases, neoplasms, or procedures in which the spleen might be removed contiguously like distal pancreatectomy), or incidental (noncontiguous procedures). Splenectomies for medical indications (n = 607, 43%) were more common than splenectomies for trauma (n = 518, 37%) or incidental splenectomies (n = 276, 20%). Splenectomy for medical reasons was associated with hematologic disease in 56 per cent, neoplastic disease in 34 per cent, and other diagnoses in 10 per cent of cases. Incidental splenectomies were most commonly associated with operations on the esophagus/stomach (32%) and colon (30%). Mortality rate and length of stay were greatest for incidental (14.4 ± 0.9 days, 10.9% mortality) compared with trauma (11.0 ± 0.5 days, 7.7% mortality) or medical (9.7 ± 0.4 days, 4.8% mortality) splenectomies (all P < 0.05 versus incidental). Our results suggest that in the era of nonoperative management of splenic injuries, medical indications now represent the most common reason for splenectomy. As laparoscopic techniques for elective splenectomy become more common, the changing indication for splenectomy has important ramifications for surgical education and training.

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“…Visi politrauminiai ligoniai, kuriems, be kitø suþalojimø, diagnozuotas ir bluþnies plyðimas, operuoti skubos tvarka, visiems atlikta splenektomija. Tokià gydymo taktikà nurodo ir dauguma kitø autoriø [11,15,16]. Pagrindiniai tokio gydymo pasirinkimo (net ir esant nedidelio laipsnio bluþnies suþalojimui) argumentai yra ðie:…”

Section: Rezultataiunclassified

Blužnies sužalojimai dėl uždaros pilvo traumos

Abalikšta¹,

Gaidamonis²,

Stanaitis³

et al. 2007

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TikslasIðanalizuoti pagrindines uþdarø pilvo traumø, kai suþalojama bluþnis, prieþastis, pasiskirstymà pagal ligoniø amþiø, lytá, organo paþeidimo laipsná. Apþvelgti ir palyginti taikytus operacinio ir konservatyvaus gydymo metodus, gulëjimo stacionare laikà ir komplikacijas. Ligoniai ir metodaiRetrospektyviai iðanalizuotos 154 pacientø, gydytø Vilniaus greitosios pagalbos universitetinës ligoninës (VGPUL) chirurgijos skyriuose nuo 1996 m. sausio 1 d. iki 2005 m. gruodþio 31 d. dël bluþnies suþalojimo po uþdaros pilvo traumos, ligos istorijos. RezultataiPer minëtà laikotarpá dël bluþnies suþalojimo po uþdaros pilvo traumos gydyta 113 vyrø ir 41 moteris. Izoliuota bluþnies trauma pasitaikë 108 atvejais (70%), o 46 atvejais (30%) kartu buvo ir kitø organø paþeidimas, daþnai dauginis (politrauma). Pagrindinës traumos prieþastys: eismo ávykiai -34%, smurtiniai suþalojimai -29%, griuvimai -10%, kritimai ið aukðèio -8%, kitos ar neþinomos prieþastys -8%, traumà neigë 11% pacientø. Vidutinis pacientø vyrø amþius -34,2 metø, moterø -39,7 metø. Pasiskirstymas pagal bluþnies paþeidimo laipsná: I° -11%, II° -22%, III° -40%, IV° -18%, V° -9%. Visi 46 politrauminiai ligoniai operuoti skubos tvarka, visiems atlikta splenektomija. Vidutinis gulëjimo laikas -21,4 dienos. 14 (30%) ið ðiø ligoniø mirë ankstyvu potrauminiu laikotarpiu nuo sunkiø gretutiniø suþalojimø. Ið 108 ligoniø, kuriems buvo izoliuota bluþnies trauma, operuoti 96 (89%) ligoniai: 90 ligoniø atlikta splenektomija, 6 -susiûta bluþnis (vienas ið jø operuotas antrà kartà dël pasikartojusio kraujavimo, atlikta splenektomija). Vidutinis operuotø ligoniø gulëjimo laikas -9,9 dienos, vëlyvu laikotarpiu 1 ligonis mirë susiformavus podiafragminiam pûliniui ir iðsivysèiusius sepsiui. Dvylika (11%) ligoniø gydyta konservatyviai. Gulëjimo ligoninëje laikas -9,6 dienos. Viena konservatyviai gydyta ligonë operuota po 4 mën. dël susidariusios bluþnies cistos, atlikta splenektomija. Kitø komplikacijø po konservatyvaus gydymo nebuvo.

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Evolution, not revolution: splenic salvage for blunt trauma in a statewide voluntary trauma system—a 10-year experience

Cited by 9 publications

References 13 publications

Non-operative management in blunt splenic trauma

Non-operative management in blunt splenic trauma

Is Splenectomy after Trauma an Endangered Species?

Blužnies sužalojimai dėl uždaros pilvo traumos

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