Splenic Angioembolization and Operative Management Rates Across Trauma Center Levels: A National Analysis of Blunt Splenic Injury Outcomes.

INTRODUCTION

This study evaluates the utilization rates and outcomes associated with splenic angioembolization (SAE) compared to operative management in both stable and unstable adult patients with high-grade blunt splenic trauma.

METHODS

This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Participant Use File database to identify adult patients with high-grade blunt splenic injuries who underwent SAE or operative management at level I and II centers. Patients were stratified by hemodynamic stability. Primary outcomes included SAE utilization rate, in-hospital mortality, and nonoperative management failure rates. Secondary outcomes included transfusion volume, intensive care unit length of stay, ventilator-free days, and complication rates.

RESULTS

SAE utilization rates were similar between level I and II trauma centers in both stable (47.0% versus 50.3%, P = 0.334) and unstable (12.5% versus 9.7%, P = 0.413) patients. Among stable patients, SAE was associated with shorter intensive care unit length of stay (β: -0.659, P = 0.008) and reduced transfusion volume (β: -204.468, P < 0.001). In hospital mortality, ventilator-free days, and complication rates were similar across groups. SAE consistently demonstrated lower splenectomy rates (5.3%-25.9%) and nonoperative management failure rates (6.1%-33.3%) across all subgroups.

CONCLUSIONS

SAE rates were similar across various level trauma centers, and it was shown to be safe and effective compared to operative management in both hemodynamically stable and unstable patients with high-grade blunt splenic injuries. Its consistent performance across trauma centers supports broader integration into management protocols.