Conservative surgery versus nonoperative management of splenic injuries in polytrauma patient

Background: The aim of the current study is to define and compare in-hospital morbidity for conservative surgery and nonoperative management of splenic trauma, in the complex polytrauma setting. Method: Retrospective study of patients admitted in Emergency Hospital of Bucharest during the last 5 years. The selection criteria were: (1) Injury Severity Score (ISS) >= 17; (2) splenic injury; (3) no splenectomy during initial management. Results: Out of 60 patients there were 36 nonoperatively managed (NOM) and 24 with a splenic salvage surgical procedure (SSSP). Mean age was 36.9 (NOM) and 30.7 (SSSP) (p >.05). Mean ISS was 26.9 (NOM) and 30.04 (SSSP) (p>.05). Out of 24 SSSP there were 10 local hemostatic applications, 3 splenoraphies and 2 partial splenectomies. There were 15% unnecessary/nontherapeutic laparotomies. Need for transfusion was 2.17 (NOM) and 4.58 (SSSP) (p=.05). Mean in-hospital stay was 10.5 (NOM) versus 16.6 (SSSP) (p >.05). There were 7 early and 13 late deaths, most of them due to cerebral trauma (MNO vs SSSP, p>.05). Conclusions: No additional early morbidity and mortality were noted, for polytrauma patients, related to splenic surgical management. Key words: polytrauma, splenic trauma, early morbidity.