A Comparative Study of Operative Versus Non-operative Management of High-Grade Splenic Injuries in a Tertiary Care Center in India

Background The spleen is one of the most common solid organs injured in blunt abdominal trauma with significant mortality. The management of splenic injury has significantly changed over the last few decades, ranging from certain splenectomies to non-operative management (NOM). Although several retrospective studies have been published on the NOM of minor spleen injuries, few studies have analyzed the results of NOM for high-grade splenic injuries. The pertinent question that we attempt to answer is, "Is it possible to manage extensive splenic injuries non-operatively?". Objectives To study the feasibility of NOM for the American Association for the Surgery of Trauma (AAST) Grade 3, 4, and 5 splenic injuries and to assess the demographic profile and cases for AAST Grade 3, 4, and 5 splenic injuries. Methods and methodology We, retrospectively, studied patients admitted with AAST Grade 3, 4, and 5 splenic injuries from blunt abdominal trauma admitted at the Government Medical College, Thiruvananthapuram, India, between January 2014 and October 2020. Their demographics, grade of splenic injuries, associated injuries, and methods of management were collected, and statistical analysis was done. Results The study included 132 patients with AAST Grade 3, 4, and 5 splenic injuries. Fifty percent of patients had Grade 3 injuries, 39.4% had Grade 4 injuries, and 10.6% were found to have Grade 5 splenic injuries. Grade 3 and 4 injuries were mainly managed non-operatively, while Grade 5 injuries had a failure rate of nearly 65% when managed non-operatively. Additionally, 73.5% of splenic injuries were successfully managed non-operatively. A significant association was noted between the severity of injuries and the need for operative management (p