Risk Factors for Failure of Splenic Angioembolization: A Multicenter Study of Level I Trauma Centers
Angioembolization (AE) is an adjunct to nonoperative management (NOM) of splenic injuries. We hypothesize that failure of AE is associated with blood transfusion, grade of injury, and technique of AE. We performed a retrospective (2010-2017) multicenter study (nine Level I trauma centers) of adult t...
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| Veröffentlicht in: | The Journal of surgical research 2021-01, Vol.257, p.227-231 |
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| creator | Bankhead-Kendall, Brittany Teixeira, Pedro Musonza, Tashinga Donahue, Tim Regner, Justin Harrell, Kelly Brown, Carlos V.R. Murry, Jason Tyroch, Alan Foreman, Michael Alhaj-Saleh, Adel Pan, Stephen Archer, David Todd, S. Rob Kao, Lillian Rodriguez, Carlos Dissanaike, Sharmila |
| description | Angioembolization (AE) is an adjunct to nonoperative management (NOM) of splenic injuries. We hypothesize that failure of AE is associated with blood transfusion, grade of injury, and technique of AE.
We performed a retrospective (2010-2017) multicenter study (nine Level I trauma centers) of adult trauma patients with splenic injuries who underwent splenic AE. Variables included patient physiology, injury grade, transfusion requirement, and embolization technique. The primary outcome was NOM failure requiring splenectomy. Secondary outcomes were mortality, complications, and length of stay.
A total of 409 patients met inclusion criteria; only 33 patients (8%) required delayed splenectomy. Patients who failed received more blood in the first 24 h (P = 0.009) and more often received massive transfusion (P = 0.01). There was no difference in failure rates for grade of injury, contrast blush on computed tomography, and branch embolized. After logistic regression, transfusion in the first 24 h was independently associated with failure of NOM (P = 0.02). Patients who failed NOM had more complications (P = 0.002) and spent more days in the intensive care unit (P |
| doi_str_mv | 10.1016/j.jss.2020.07.058 |
| format | Article |
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We performed a retrospective (2010-2017) multicenter study (nine Level I trauma centers) of adult trauma patients with splenic injuries who underwent splenic AE. Variables included patient physiology, injury grade, transfusion requirement, and embolization technique. The primary outcome was NOM failure requiring splenectomy. Secondary outcomes were mortality, complications, and length of stay.
A total of 409 patients met inclusion criteria; only 33 patients (8%) required delayed splenectomy. Patients who failed received more blood in the first 24 h (P = 0.009) and more often received massive transfusion (P = 0.01). There was no difference in failure rates for grade of injury, contrast blush on computed tomography, and branch embolized. After logistic regression, transfusion in the first 24 h was independently associated with failure of NOM (P = 0.02). Patients who failed NOM had more complications (P = 0.002) and spent more days in the intensive care unit (P < 0.0001), on the ventilator (P = 0.0001), and in the hospital (P < 0.0001). Patients who failed NOM had a higher mortality (15% versus 3%, P = 0.007), and delayed splenectomy was independently associated with mortality (odds ratio, 4.2; 95% confidence interval, 1.2-14.7; P = 0.03).
AE for splenic injury leads to effective NOM in 92% of patients. Transfusion in the first 24 h is independently associated with failure of NOM. Patients who required a delayed splenectomy suffered more complications and had higher hospital length of stay. Failure of NOM is independently associated with a fourfold increase in mortality.
•Splenic angioembolization in trauma is safe.•There is no difference in embolization failure rates for grade of splenic injury.•There is no difference in failure rate for patients with a contrast blush on CT.•Transfusion in the first 24 h is associated with splenic embolization failure.•Failure of splenic embolization is associated with five-fold increase in mortality.</description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2020.07.058</identifier><identifier>PMID: 32861100</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdominal Injuries - diagnosis ; Abdominal Injuries - mortality ; Abdominal Injuries - therapy ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Blood Transfusion - statistics & numerical data ; Computed Tomography Angiography ; Embolization, Therapeutic - statistics & numerical data ; Female ; Humans ; Length of Stay - statistics & numerical data ; Male ; Middle Aged ; Nonoperative management failure ; Retrospective Studies ; Risk Factors ; Spleen - blood supply ; Spleen - injuries ; Spleen - surgery ; Splenectomy - statistics & numerical data ; Splenic angioembolization ; Splenic Artery - diagnostic imaging ; Time-to-Treatment ; Trauma ; Trauma Centers - statistics & numerical data ; Treatment Failure ; Young Adult</subject><ispartof>The Journal of surgical research, 2021-01, Vol.257, p.227-231</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-c171963c7dc7b7b34185d4bfcaf2ff828923ac38f27a122af64880c9d7e34a1a3</citedby><cites>FETCH-LOGICAL-c353t-c171963c7dc7b7b34185d4bfcaf2ff828923ac38f27a122af64880c9d7e34a1a3</cites><orcidid>0000-0002-7258-7977</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022480420305199$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32861100$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bankhead-Kendall, Brittany</creatorcontrib><creatorcontrib>Teixeira, Pedro</creatorcontrib><creatorcontrib>Musonza, Tashinga</creatorcontrib><creatorcontrib>Donahue, Tim</creatorcontrib><creatorcontrib>Regner, Justin</creatorcontrib><creatorcontrib>Harrell, Kelly</creatorcontrib><creatorcontrib>Brown, Carlos V.R.</creatorcontrib><creatorcontrib>Murry, Jason</creatorcontrib><creatorcontrib>Tyroch, Alan</creatorcontrib><creatorcontrib>Foreman, Michael</creatorcontrib><creatorcontrib>Alhaj-Saleh, Adel</creatorcontrib><creatorcontrib>Pan, Stephen</creatorcontrib><creatorcontrib>Archer, David</creatorcontrib><creatorcontrib>Todd, S. Rob</creatorcontrib><creatorcontrib>Kao, Lillian</creatorcontrib><creatorcontrib>Rodriguez, Carlos</creatorcontrib><creatorcontrib>Dissanaike, Sharmila</creatorcontrib><creatorcontrib>Texas Trauma Study Group</creatorcontrib><title>Risk Factors for Failure of Splenic Angioembolization: A Multicenter Study of Level I Trauma Centers</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Angioembolization (AE) is an adjunct to nonoperative management (NOM) of splenic injuries. We hypothesize that failure of AE is associated with blood transfusion, grade of injury, and technique of AE.
We performed a retrospective (2010-2017) multicenter study (nine Level I trauma centers) of adult trauma patients with splenic injuries who underwent splenic AE. Variables included patient physiology, injury grade, transfusion requirement, and embolization technique. The primary outcome was NOM failure requiring splenectomy. Secondary outcomes were mortality, complications, and length of stay.
A total of 409 patients met inclusion criteria; only 33 patients (8%) required delayed splenectomy. Patients who failed received more blood in the first 24 h (P = 0.009) and more often received massive transfusion (P = 0.01). There was no difference in failure rates for grade of injury, contrast blush on computed tomography, and branch embolized. After logistic regression, transfusion in the first 24 h was independently associated with failure of NOM (P = 0.02). Patients who failed NOM had more complications (P = 0.002) and spent more days in the intensive care unit (P < 0.0001), on the ventilator (P = 0.0001), and in the hospital (P < 0.0001). Patients who failed NOM had a higher mortality (15% versus 3%, P = 0.007), and delayed splenectomy was independently associated with mortality (odds ratio, 4.2; 95% confidence interval, 1.2-14.7; P = 0.03).
AE for splenic injury leads to effective NOM in 92% of patients. Transfusion in the first 24 h is independently associated with failure of NOM. Patients who required a delayed splenectomy suffered more complications and had higher hospital length of stay. Failure of NOM is independently associated with a fourfold increase in mortality.
•Splenic angioembolization in trauma is safe.•There is no difference in embolization failure rates for grade of splenic injury.•There is no difference in failure rate for patients with a contrast blush on CT.•Transfusion in the first 24 h is associated with splenic embolization failure.•Failure of splenic embolization is associated with five-fold increase in mortality.</description><subject>Abdominal Injuries - diagnosis</subject><subject>Abdominal Injuries - mortality</subject><subject>Abdominal Injuries - therapy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Transfusion - statistics & numerical data</subject><subject>Computed Tomography Angiography</subject><subject>Embolization, Therapeutic - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nonoperative management failure</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Spleen - blood supply</subject><subject>Spleen - injuries</subject><subject>Spleen - surgery</subject><subject>Splenectomy - statistics & numerical data</subject><subject>Splenic angioembolization</subject><subject>Splenic Artery - diagnostic imaging</subject><subject>Time-to-Treatment</subject><subject>Trauma</subject><subject>Trauma Centers - statistics & numerical data</subject><subject>Treatment Failure</subject><subject>Young Adult</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtu2zAQRYkgRe2k_YBsCi6zkcKHJFLtyjDixICLArW7JihqGNCRRJeUAqRfH7p2uuxqOOC5F5iD0A0lOSW0utvn-xhzRhjJichJKS_QnJK6zGQl-CWaE8JYVkhSzNBVjHuS9lrwj2jGmawoJWSO2p8uPuOVNqMPEVsf0tt1UwDsLd4eOhicwYvhyXnoG9-5P3p0fviKF_j71I3OwDBCwNtxal-PiQ28QIfXeBf01Gu8_PsdP6EPVncRPp_nNfq1ut8tH7PNj4f1crHJDC_5mBkqaF1xI1ojGtHwgsqyLRprtGXWSiZrxrXh0jKhKWPaVoWUxNStAF5oqvk1uj31HoL_PUEcVe-iga7TA_gpKlbwZKYuyiqh9ISa4GMMYNUhuF6HV0WJOspVe5XkqqNcRYRKclPmy7l-anpo_yXebSbg2wmAdOSLg6CicTAYaF0AM6rWu__UvwHpfYoz</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Bankhead-Kendall, Brittany</creator><creator>Teixeira, Pedro</creator><creator>Musonza, Tashinga</creator><creator>Donahue, Tim</creator><creator>Regner, Justin</creator><creator>Harrell, Kelly</creator><creator>Brown, Carlos V.R.</creator><creator>Murry, Jason</creator><creator>Tyroch, Alan</creator><creator>Foreman, Michael</creator><creator>Alhaj-Saleh, Adel</creator><creator>Pan, Stephen</creator><creator>Archer, David</creator><creator>Todd, S. 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Rob</creatorcontrib><creatorcontrib>Kao, Lillian</creatorcontrib><creatorcontrib>Rodriguez, Carlos</creatorcontrib><creatorcontrib>Dissanaike, Sharmila</creatorcontrib><creatorcontrib>Texas Trauma Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bankhead-Kendall, Brittany</au><au>Teixeira, Pedro</au><au>Musonza, Tashinga</au><au>Donahue, Tim</au><au>Regner, Justin</au><au>Harrell, Kelly</au><au>Brown, Carlos V.R.</au><au>Murry, Jason</au><au>Tyroch, Alan</au><au>Foreman, Michael</au><au>Alhaj-Saleh, Adel</au><au>Pan, Stephen</au><au>Archer, David</au><au>Todd, S. Rob</au><au>Kao, Lillian</au><au>Rodriguez, Carlos</au><au>Dissanaike, Sharmila</au><aucorp>Texas Trauma Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Failure of Splenic Angioembolization: A Multicenter Study of Level I Trauma Centers</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2021-01</date><risdate>2021</risdate><volume>257</volume><spage>227</spage><epage>231</epage><pages>227-231</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract>Angioembolization (AE) is an adjunct to nonoperative management (NOM) of splenic injuries. We hypothesize that failure of AE is associated with blood transfusion, grade of injury, and technique of AE.
We performed a retrospective (2010-2017) multicenter study (nine Level I trauma centers) of adult trauma patients with splenic injuries who underwent splenic AE. Variables included patient physiology, injury grade, transfusion requirement, and embolization technique. The primary outcome was NOM failure requiring splenectomy. Secondary outcomes were mortality, complications, and length of stay.
A total of 409 patients met inclusion criteria; only 33 patients (8%) required delayed splenectomy. Patients who failed received more blood in the first 24 h (P = 0.009) and more often received massive transfusion (P = 0.01). There was no difference in failure rates for grade of injury, contrast blush on computed tomography, and branch embolized. After logistic regression, transfusion in the first 24 h was independently associated with failure of NOM (P = 0.02). Patients who failed NOM had more complications (P = 0.002) and spent more days in the intensive care unit (P < 0.0001), on the ventilator (P = 0.0001), and in the hospital (P < 0.0001). Patients who failed NOM had a higher mortality (15% versus 3%, P = 0.007), and delayed splenectomy was independently associated with mortality (odds ratio, 4.2; 95% confidence interval, 1.2-14.7; P = 0.03).
AE for splenic injury leads to effective NOM in 92% of patients. Transfusion in the first 24 h is independently associated with failure of NOM. Patients who required a delayed splenectomy suffered more complications and had higher hospital length of stay. Failure of NOM is independently associated with a fourfold increase in mortality.
•Splenic angioembolization in trauma is safe.•There is no difference in embolization failure rates for grade of splenic injury.•There is no difference in failure rate for patients with a contrast blush on CT.•Transfusion in the first 24 h is associated with splenic embolization failure.•Failure of splenic embolization is associated with five-fold increase in mortality.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32861100</pmid><doi>10.1016/j.jss.2020.07.058</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-7258-7977</orcidid></addata></record> |
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| subjects | Abdominal Injuries - diagnosis Abdominal Injuries - mortality Abdominal Injuries - therapy Adolescent Adult Aged Aged, 80 and over Blood Transfusion - statistics & numerical data Computed Tomography Angiography Embolization, Therapeutic - statistics & numerical data Female Humans Length of Stay - statistics & numerical data Male Middle Aged Nonoperative management failure Retrospective Studies Risk Factors Spleen - blood supply Spleen - injuries Spleen - surgery Splenectomy - statistics & numerical data Splenic angioembolization Splenic Artery - diagnostic imaging Time-to-Treatment Trauma Trauma Centers - statistics & numerical data Treatment Failure Young Adult |
| title | Risk Factors for Failure of Splenic Angioembolization: A Multicenter Study of Level I Trauma Centers |
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