Long-term follow-up of infection, malignancy, thromboembolism, and all-cause mortality risks after splenic artery embolization for blunt splenic injury: comparison with splenectomy and conservative management.

Background: Non-operative management, including splenic artery embolization, is preferred for blunt splenic injuries, but its long-term risks need further investigation. Long-term splenic functions were assessed in patients with blunt splenic injuries, hypothesizing that splenic artery embolization would preserve function and reduce long-term risks.

Methods: This retrospective cohort study used Taiwan's National Health Insurance Research Database to analyse patients with blunt splenic injuries from 2004 to 2019. To balance baseline characteristics across the treatment groups, inverse probability of treatment weighting was used based on propensity scores. Outcomes of main interest included the incidence and cumulative infection, malignancy, thromboembolism, and all-cause mortality risks after one year.

Results: Altogether, 18 771 patients sustained blunt splenic injuries; 8195 were eligible for inclusion. The mean age was 38.4 years, with male predominance (70.5%). Outcomes were compared between splenectomy, splenic artery embolization, and conservative treatment groups. After applying a generalized boosted model with inverse probability of treatment weighting, patients who underwent splenic artery embolizations or conservative treatment had lower infection risks than those in the splenectomy group. The conservative treatment group had a lower malignancy risk than the splenectomy group. Patients with blunt splenic injuries who underwent splenic artery embolizations or conservative treatment had a lower thromboembolism risk than those who underwent splenectomies.

Conclusion: Long-term infection, malignancy, thromboembolism, and all-cause mortality risks were not significantly different between the splenic artery embolization and conservative treatment groups. In contrast, patients who underwent splenectomies had increased infection, malignancy, thromboembolism, and all-cause mortality risks. Clinicians must be familiar with the potential long-term complications associated with the different treatment modalities for splenic injuries and provide appropriate prophylactic measures.