Abstract:
BACKGROUND:Strategies for splenic preservation for trauma patients have gained acceptance; however, meaningful outcome evaluations have not been performed. To better understand the consequences of managing patients with splenic injuries, the short-term outcomes of different types of management strategies were examined. We defined splenic preservation as observation of splenic injury, splenic embolization, and splenorrhaphy. We defined splenic salvage as splenic embolization and splenorrhaphy. METHODS:Retrospective descriptive study examining splenic injury management of adult patients at an urban level 1 trauma center. RESULTS:During 31 months, 170 splenic injuries were captured by the trauma registry. Average age was 31.7 years, and the average Injury Severity Score (ISS) was 22.7; patients had multiple associated injuries. The average length of stay was 15.7 days, and mortality that was not associated with splenic injury was 10%. Fifty-eight patients underwent immediate splenectomy, with 3 patients requiring percutaneous drainage for pancreatic leaks and 1 patient requiring reoperation for a gastrocutaneous fistula (overall morbidity 6.9%). Eighty five patients were managed nonoperatively, with 10 patients (11.9%) failing expectant management; they underwent subsequent splenectomies. Eleven patients were managed by splenic artery embolization. Three patients (27.2%) required further intervention; 1 required re-embolization; and 2 required splenectomy. Sixteen patients underwent surgical splenorrhaphy, with 2 patients failing (12.5%), thus requiring eventual splenectomies. Morbidity for splenic preservation (observation, splenic embolization, and splenorrhaphy) was 13.4%, whereas morbidity for splenic salvage (embolization and splenorrhaphy) was 18.5%. CONCLUSIONS:In the adult population, splenic preservation has 2-fold and splenic salvage close to 3-fold morbidity compared with immediate splenectomy in management of patients with blunt and penetrating splenic injuries.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Kaseje N,Agarwal S,Burch M,Glantz A,Emhoff T,Burke P,Hirsch Edoi
10.1016/j.amjsurg.2007.07.037subject
Has Abstractpub_date
2008-08-01 00:00:00pages
213-7issue
2eissn
0002-9610issn
1879-1883pii
S0002-9610(08)00259-6journal_volume
196pub_type
杂志文章abstract:INTRODUCTION:While women represent approximately half of all medical students, only 38% of general surgery residents are women. The objective of this study is to explore how access to mentors and organizational support affects career choices. METHODS:In June of 2016, a survey was sent to medical students at a single i...
journal_title:American journal of surgery
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更新日期:2002-12-01 00:00:00
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更新日期:2015-01-01 00:00:00
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journal_title:American journal of surgery
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更新日期:2018-02-01 00:00:00
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journal_title:American journal of surgery
pub_type: 杂志文章
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更新日期:2015-02-01 00:00:00