NYU School of Medicine/Bellevue Hospital, NYU School of Medicine Department of Surgery, 462 First Avenue, NY, 10016, USA.
University of Maryland R. Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD, 21201, USA.
Am J Surg. 2020 Sep;220(3):778-782. doi: 10.1016/j.amjsurg.2020.01.053. Epub 2020 Feb 6.
While the incidence of geriatric trauma continues to increase, the management of high-grade blunt splenic injury (BSI) in the elderly remains controversial. Among this population, data evaluating survival rates following non-operative and operative management are inconsistent. We analyzed mortality risk in geriatric patients with high-grade BSI based on operative vs. non-operative management.
A retrospective analysis of the National Trauma Database identified patients with isolated, high-grade (AIS ≥ 3) BSI from 2014 to 2015. Patients were stratified into three groups: non-elderly (<65 years), elderly (65-79 years), and advanced age (80 years and older). Each age group was stratified into three management groups: non-operative (including embolization), initial operative management (OR within 24 h), and failed non-operative management. Patient characteristics and outcomes were compared. Multivariable logistic regression estimated association with mortality.
5560 patients with isolated, high-grade BSI were identified. In the group that failed NOM, mortality was 2% in non-elderly patients, versus 22.2% in elderly patients and 50% in patients of advanced age (p < .01). In this group, patients over 80 years old spent an average of 6.5 days longer in the ICU vs. non-elderly patients (median 10.5 days, IQR [6.75, 19.5] vs. 4 days, IQR [3,6], p = 0.02). In patients with isolated, high grade BSI, age was independently associated with mortality (AOR 1.02; p < 0.01). Elderly patients who required surgery were over three times more likely to die (AOR 3.39; p < 0.01). Advanced age patients who required surgery were over eight times more likely to die (AOR 8.1; p < 0.01).
For patients with BSI, age is independently associated with death in both operative and non-operative cases.
尽管老年创伤的发病率持续上升，但老年人中高等级钝性脾损伤（BSI）的处理仍存在争议。在这一人群中，关于非手术和手术治疗后生存率的数据不一致。我们根据手术与非手术治疗分析了老年高等级 BSI 患者的死亡风险。
对国家创伤数据库进行回顾性分析，确定了 2014 年至 2015 年期间孤立性高等级（AIS≥3）BSI 的患者。患者分为三组：非老年组（<65 岁）、老年组（65-79 岁）和高龄组（≥80 岁）。每个年龄组分为三组治疗组：非手术（包括栓塞）、初始手术治疗（24 小时内手术）和非手术治疗失败。比较患者特征和结局。多变量逻辑回归估计与死亡率的相关性。
共确定了 5560 例孤立性高等级 BSI 患者。在非手术治疗失败组中，非老年患者的死亡率为 2%，而老年患者为 22.2%，高龄患者为 50%（p<0.01）。在该组中，80 岁以上的患者在 ICU 中平均多住 6.5 天（中位数 10.5 天，IQR[6.75,19.5]与 4 天，IQR[3,6]，p=0.02）。在孤立性高等级 BSI 患者中，年龄与死亡率独立相关（AOR 1.02；p<0.01）。需要手术的老年患者死亡的可能性增加了三倍以上（AOR 3.39；p<0.01）。需要手术的高龄患者死亡的可能性增加了八倍以上（AOR 8.1；p<0.01）。
对于 BSI 患者，手术和非手术治疗的患者中，年龄与死亡独立相关。
