Twenty Years of Splenic Preservation in Trauma: Lower Early Infection Rate Than in Splenectomy

Gauer, Jean-Marc; Gerber-Paulet, Susanne; Seiler, Christian; Schweizer, W

doi:10.1007/s00268-008-9733-3

Cited by 39 publications

(18 citation statements)

References 72 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The vast majority of studies comparing surgical and nonsurgical BSI management methods describe more infectious complications in OM (25)(26)(27), whereas others found a higher sepsis rate after SAE: 12% versus 5%, respectively, in the Duchesne et al study (28). Splenectomy has even been found as a risk factor independent of sepsis outcome in the study reported by Demetriades et al (27).…”

Section: Discussionmentioning

confidence: 70%

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Frandon¹,

Rodière²,

Arvieux³

et al. 2015

Diagn Interv Radiol

View full text Add to dashboard Cite

B lunt splenic injury (BSI) has become more frequently managed nonoperatively over the years, with the results improved by the contribution of embolization, making it possible to treat active hemorrhages as well as prevent hemorrhages in high-grade trauma of the spleen without active bleeding (1-10). Three methods of splenic artery injury management can be defined: operative management (OM), nonoperative management (NOM), and nonoperative management with splenic artery embolization (SAE).The complication rate in relation to different management methods (operative and nonoperative) continues to be debated. The description and prevalence of these complications varies greatly from one series to another (7,(11)(12)(13), resulting from the confusion existing between adverse events related to injury and those related to treatment. The severity of polytrauma is taken into account using the patients' injury severity score (ISS), and several studies have shown that a high ISS was related to more nonsurgical treatment failures (14). Certain authors have taken a specific interest in the parameters of multiple injuries and shown that lesions of associated organs (pancreas, spinal cord, limbs) were related to more complications (15-17). The severity of trauma and associated lesions could therefore be considered confounding factors resulting in treatment failure and complications. A better understanding of these complications could help in preventing them.The objectives of this study were to compare outcomes of the three types of BSI management, determine if there are any complications statistically related to management methods, and demonstrate risk factors taking polytrauma into account. We focused on associated injuries and early adverse events. Multivariate analysis was performed on 23 prognostic factors to find predictors. RESULTSThe total survival rate was 97.1%, with four deaths all occurred in the OM group. The spleen salvage rate was 91% in NOM and SAE. At least one adverse event was observed in 32.8%, 62%, and 96% of patients in NOM, SAE, and OM groups, respectively (P < 0.001). We found significantly more deaths, infectious complications, pleural drainage, acute renal failures, and pancreatitis in OM and more pseudocysts in SAE. Six prognostic factors were statistically significant for one or more adverse events: simplified acute physiology score 2 ≥25 for almost all adverse events, age ≥50 years for acute respiratory syndrome, limb fracture for secondary bleeding, thoracic injury for pleural drainage, and at least one associated injury for pseudocyst. Adverse events were not related to the type of BSI management. CONCLUSIONPatients with BSI present worse outcome and more adverse events in OM, but this is related to the severity of injury. The main predictor of adverse events remains the severity of injury.

show abstract

Section: Discussionmentioning

confidence: 70%

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Frandon¹,

Rodière²,

Arvieux³

et al. 2015

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…This reflects the changing practice regarding splenic and hepatic injuries with a more frequent use of nonoperative treatment strategies, which have been associated with lower rates of abdominal infection and sepsis in previous reports as well (7,40,41). Multiple surgical procedures have been described to affect the immune system as "second hits" (7,11,38,42).…”

Section: Discussionmentioning

confidence: 83%

Epidemiology and risk factors of sepsis after multiple trauma: An analysis of 29,829 patients from the Trauma Registry of the German Society for Trauma Surgery*

Wafaisade

Lefering

Bouillon

et al. 2011

Critical Care Medicine

157

130

View full text Add to dashboard Cite

The incidence of sepsis decreased significantly over the study period; however, in this decade the incidence remained unchanged. Although overall mortality from multiple trauma has declined significantly since 1993, there has been no significant decrease of mortality in the subgroup of septic trauma patients. Thus, sepsis has remained a challenging complication after trauma during the past 2 decades. Recognition of the identified risk factors may guide early diagnostic workup and help to reduce septic complications after multiple trauma.

show abstract

“…For example, the risk of infection, overwhelming postsplenectomy infection, percentage that required hospitalization, and mortality rate were extracted from studies reporting these outcomes. [9][10][11][12][13][14] Because mortality rates in patients with SAAs are higher than those in the general population, diseasespecific mortality rates were modeled. No specific mortality rates for patients with SAAs were reported; thus, mortality rates for patients with abdominal aortic aneurysms (AAAs) were used.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms

Hogendoorn

Lavida

Hunink³

et al. 2015

Journal of Vascular Surgery

View full text Add to dashboard Cite

EV is the most cost-effective treatment for most patient groups with SAAs, independent of the sex and risk profile of the patient. EV is superior to OPEN, being both cost-saving and more effective in all age groups. Elderly patients should be considered for CONS, based on the high costs in relation to the very small gain in health when treated with EV. The very elderly should be treated with CONS.

show abstract

Twenty Years of Splenic Preservation in Trauma: Lower Early Infection Rate Than in Splenectomy

Abstract: Splenic preservation in patients with blunt splenic injury by operative or nonoperative treatment leads to lower early infection rates in adults and, therefore, should be advocated.

Cited by 39 publications

References 72 publications

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Blunt splenic injury: are early adverse events related to trauma, nonoperative management, or surgery?

Epidemiology and risk factors of sepsis after multiple trauma: An analysis of 29,829 patients from the Trauma Registry of the German Society for Trauma Surgery*

Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms

Contact Info

Product

Resources

About