The real risk of splenectomy after discharge home following nonoperative management of blunt splenic injury

J Trauma. 2009 Jun;66(6):1531-6; discussion 1536-8. doi: 10.1097/TA.0b013e3181a4ed11.


Background: The postdischarge natural history of nonoperative blunt splenic injury (BSI) has not been adequately elucidated. As a result, outpatient management is poorly defined. Population-based outpatient data would provide clinicians with an estimate of baseline risk of postdischarge splenectomy after nonoperative management of BSI. The purpose of this study was to analyze, using population-based data, the 180-day risk of splenectomy in a clinically relevant sample.

Methods: A statewide Hospital Discharge Data System containing patient level data was used to construct a prospective cohort of persons 18 or older with nonoperatively managed BSI admitted to any hospital in the state from 2000 to 2005 and discharged home. Re-admission for splenectomy within 180 days from the original injury date was analyzed.

Results: Four thousand one hundred three persons with BSI were admitted from 2000 to 2005. Two thousand nine hundred seventy-one (72.4%) were managed nonoperatively. One thousand nine hundred thirty-two (47.1%) were discharged. Twenty-seven of 1,932 were re-admitted for splenectomy within 180 days. Median time from injury to re-admission for splenectomy was 8 days (range, 3-146). The 180-day risk of splenectomy was 1.4% after nonoperative management and discharge home.

Conclusions: Nonoperative management of BSI results in a 180-day risk of re-admission for splenectomy of 1.4% for persons discharged home. A majority of splenectomies occur within 8 days. Explicit patient education and close follow-up are necessary.

MeSH terms

  • Abdominal Injuries / surgery
  • Abdominal Injuries / therapy*
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Spleen / injuries*
  • Splenectomy / statistics & numerical data*
  • Treatment Outcome
  • Wounds, Nonpenetrating / surgery
  • Wounds, Nonpenetrating / therapy*
  • Young Adult