Comparing Readmissions and Infectious Complications of Blunt Splenic Injuries Using a Statewide Database

Olubode Olufajo, Brigham and Women's Hospital, Boston, MA; Katherine Williams, Brigham and Women's Hospital, Boston, MA; Arturo Rios Diaz, Brigham and Women's Hospital, Boston, MA; Zara Cooper, Brigham and Women's Hospital, Boston, MA; Joaquim Havens, Brigham and Women's Hospital, Boston, MA; Jonathan Gates, Brigham and Women's Hospital, Boston, MA; Allan Peetz, Brigham and Women's Hospital, Boston, MA; Ali Salim, Brigham and Women's Hospital, Boston, MA; Reza Askari, Brigham & Women's Hospital

Conservative management options of blunt splenic injuries (BSI), including the use of splenic artery embolization (SAE) are well described and an acceptable management strategy. However, to date, long term outcomes on readmission rates and infectious complications comparing different management strategies are lacking.

SAE does not reduce the risk of infectious complications when compared with operative interventions.

Patients ages 18-64 that sustained BSI were identified in the California State Inpatient Database (2007-11), Healthcare Cost and Utilization Project (HCUP), were categorized into three modes of management: non-operative (NOM), SAE, and operative management (OM). The cumulative incidence of infections (surgical site infections, pneumonia, urinary tract infections, and sepsis) requiring readmission at different time points after injury were calculated for each mode of treatment and differences were identified using Chi square tests. Patient and management factors associated with infectious readmissions were determined using multivariate logistic regression models.

Out of a total of 4,666 BSI patients, 2,830 (60.7%) had NOM, 281 (6%) underwent SAE, and 1,555 (33.3%) had OM. Overall 30-day readmission rate was 8.45%, and 20% were due to infections. Table 1 shows the cumulative incidence of infectious complications during admission, at 30 days and one year after injury across all management options. There were no statistically significant differences in the infectious complications between the SAE and OM groups at any given time period (Table 2).  Multivariate analyses showed Charlson Score ≥ 2, length of index admission >7 days, and both OM and SAE (compared to NOM) were associated with infectious readmissions at 30 days and at 1 year.

Although infectious complications are equally common for BSI despite management strategies during the initial admission, infections after SAE and OM are dramatically higher than NOM by 30 days after injury. Interestingly, infectious complications with SAE and OM are equal throughout follow up.