Surgical Treatment versus Conservative Management of Splenic Rupture: Outcomes and Risk Factors

Abstract

Objective: This study aimed to evaluate the outcome and risk factors in operative and non-operativemanagement of splenic injury.Methods: This cross-sectional study was conducted on patients with traumatic splenic injuries who werehospitalized in Kashani Hospital (Isfahan, Iran) from 2017 to 2019. The studied variables were extracted fromthe medical records of the enrolled participants. The outcomes such as mortality complications and risk factorswere compared based on treatment methods.Results: A total of 240 patients were investigated. The mean age of the patients was 29.8±12.2, with 180(77.5%) patients being men. 154 (64.2%) patients underwent operative treatment. The mortality rate was 18.9%and 4.6% among operative and non-operative groups (p<0.001). Complications were observed in 11.5% and46.1% of non-operative and operative groups, respectively (p<0.001). Operative treatment inversely correlatedwith mortality (p<0.001) and complications (p<0.05). Splenic injury severity was correlated positivelywith mortality (p<0.001) and negatively with complications (p<0.001). Unstable hemodynamic status waspositively correlated with complications (p<0.001). Age had a positive correlation with mortality (p<0.001)and complications (p<0.001). Male sex had a negative correlation with complications (p<0.001). GCS score andadmission were positively correlated with mortality (p<0.001). There was no statistically significant correlationbetween correlated injuries and outcomes (p≥0.05).Conclusion: Patients who received surgery had higher rates of mortality and complications. However, aftercontrolling for confounders, operative treatment was found to be inversely correlated with mortality andcomplications.

Keywords

• splenic rupture
• conservative treatment
• splenectomy
• injuries