Postdischarge complications following nonoperative management of blunt splenic injury

Gil Freitas; Olubode A Olufajo; Khaled Hammouda; Elissa Lin; Zara Cooper; Joaquim M Havens; Reza Askari; Ali Salim

doi:10.1016/j.amjsurg.2015.11.018

Postdischarge complications following nonoperative management of blunt splenic injury

Am J Surg. 2016 Apr;211(4):744-749.e1. doi: 10.1016/j.amjsurg.2015.11.018. Epub 2016 Jan 6.

Authors

Gil Freitas¹, Olubode A Olufajo², Khaled Hammouda³, Elissa Lin⁴, Zara Cooper², Joaquim M Havens², Reza Askari², Ali Salim⁵

Affiliations

¹ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
² Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02120, USA.
³ Surgical ICU Translational Research Center, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
⁴ Faculty of Arts and Sciences, Harvard University, Cambridge, MA 02138, USA.
⁵ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02120, USA. Electronic address: asalim1@partners.org.

PMID: 26830714
DOI: 10.1016/j.amjsurg.2015.11.018

Abstract

Background: Nonoperative management (NOM) is the standard of care in majority of blunt splenic injuries. However, little is known about the postdischarge complications.

Methods: Patients admitted for blunt splenic injury were identified in the California State Inpatient Database (2007 to 2011). We examined patterns and risk factors for postdischarge complications among these patients.

Results: In total, 2,704 (61.45%) patients had NOM without splenic artery embolization (SAE) and 257 (5.84%) had NOM with adjunct SAE. Thirty-day readmission rate was higher in those who had adjunct SAE (12.84% vs 7.36%, P = .002). Subsequent operations during readmission were seen in 18.10% of readmitted patients and 38.10% of all patients were readmitted at nonindex hospitals. Major diagnoses on readmission were spleen injury (36.2%) and respiratory complications (9.05%). Adjunct SAE was an independent risk factor for readmission (adjusted odds ratio 1.82, 95% confidence interval 1.19 to 2.78).

Conclusions: Nearly one fifth of readmitted patients initially managed nonoperatively required an operative intervention. Improving predischarge assessments and postdischarge follow-up may reduce readmissions among these patients.

Keywords: Abdominal injury; Nonoperative management; Readmission; Risk factors; Splenic injury; Trauma.

MeSH terms

Abdominal Injuries / complications*
Abdominal Injuries / surgery
Abdominal Injuries / therapy*
Adolescent
Adult
California
Female
Humans
Male
Middle Aged
Patient Discharge
Patient Readmission / statistics & numerical data
Risk Factors
Spleen / injuries*
Time Factors
Wounds, Nonpenetrating / complications*
Wounds, Nonpenetrating / surgery
Wounds, Nonpenetrating / therapy*