The Real Risk of Splenectomy After Discharge Home Following Nonoperative Management of Blunt Splenic Injury

Background. The postdischarge natural history of nonoperative blunt splenic injury (BSI) has not been adequately elucidated. As a result, outpatient management is poorly defined. Population-based outpatient data would provide clinicians with an estimate of baseline risk of postdischarge splenectomy after nonoperative management of BSI. The purpose of this study was to analyze, using population-based data, the 180-day risk of splenectomy in a clinically relevant sample. Methods: A statewide Hospital Discharge Data System containing patient level data was used to construct a prospective cohort of persons 18 or older with nonoperatively managed BSI admitted to any hospital in the state from 2000 to 2005 and discharged home. Re-admission for splenectomy within 180 days from the original injury date was analyzed. Results: Four thousand one hundred three persons with BSI were admitted from 2000 to 2005. Two thousand nine hundred seventy-one (72.4%) were managed nonoperatively. One thousand nine hundred thirty-two (47.1%) were discharged. Twenty-seven of 1,932 were readmitted for splenectomy within 180 days. Median time from injury to re-admission for splenectomy was 8 days (range, 3-146). The 180-day risk of splenectomy was 1.4% after nonoperative management and discharge home. Conclusions: Nonoperative management of BSI results in a 180-day risk of re-admission for splenectomy of 1.4% for persons discharged home. A majority of splenectomies occur within 8 days. Explicit patient education and close follow-up are necessary.