Variation Among Trauma Centers in the Use of Angioembolization and Splenectomy Rate in Isolated High-Grade Blunt Splenic Injuries.

Abstract

Background: Non-operative management (NOM) is often successful with an adjunctive use of splenic angioembolization (SAE) in patients with high-grade blunt splenic injuries (BSI). This study aimed to evaluate the variation between US trauma centers in the use of SAE for high-grade BSI undergoing NOM.

Methods: This retrospective cohort study utilized the American College of Surgeons Trauma Quality Improvement Program database. We included adult patients (age ≥ 16 years) with isolated high-grade BSI (Abbreviated Injury Scale 3-5) from 2013 to 2021. A logistic regression model was developed to estimate the use of SAE, and trauma centers were stratified by the observed to estimated SAE ratio using tertile ranges: low, medium, and high tendencies for the use of SAE. Hierarchical logistic regression accounted for clustering at the institution level and identified factors associated with overall splenectomy.

Results: A total of 8729 patients were included. After adjusting for trauma center case mix, the use of SAE was associated with a low likelihood of overall splenectomy (odds ratio [OR]: 0.12, 95% confidence interval [CI]: 0.09-0.14, p < 0.01). Compared with low tendency centers, medium tendency centers had an OR of 0.88 (95% CI: 0.76-1.01, p = 0.07) and high tendency centers had an OR of 0.79 (95% CI: 0.67-0.91, p < 0.01) for splenectomy.

Conclusion: A significant variation exists among US trauma centers in the use of SAE for the management of isolated high-grade BSI. Trauma centers with higher tendencies for SAE use were associated with lower splenectomy rates even after the adjustment of the use of SAE.