Cho Nam Yong, Kwon Bill, Aguayo Esteban, Liu Zeyu, Tillou Areti, Benharash Peyman
Center for Advanced Surgical and Interventional Technology (CASIT), David Geffen School of Medicine, University of California, Los Angeles, CA, United States of America.
Surg Open Sci. 2025 Jul 2;27:61-67. doi: 10.1016/j.sopen.2025.06.011. eCollection 2025 Sep.
Splenic injury (BSI) is present in nearly 45 % of abdominal blunt trauma cases in the US and splenic artery embolization (SAE) has been increasingly utilized to manage BSI in recent years. However, SAE failure necessitating delayed splenectomy remains a critical concern with significant implications for patient outcomes and healthcare resource utilization.
We conducted a retrospective cohort study utilizing the 2016-2021 Nationwide Readmissions Database. Adult patients (≥18 years) with BSI undergoing SAE or splenectomy were included. Early embolization was defined as SAE within 48 h of admission. Failure of SAE (FE) was defined as splenectomy following unsuccessful SAE during the index hospitalization or within 30 days post-discharge. Multivariable regression models were developed to assess the association of FE with in-hospital mortality, length of stay (LOS), and costs.
Of 44,750 included patients, 17,921 (40.0 %) underwent SAE as an initial operative approach. Rates of failed embolization remained stable over the study period (2016: 8.1 % vs 2021: 9.4 %, nptrend = 0.86), as did mortality following FE (2016: 1.9 % vs 2021: 1.3 %, nptrend = 0.05). After risk adjustment, early embolization was associated with reduced odds of FE (AOR 0.78, 95%CI 0.64-0.95). FE was associated with significantly increased odds of mortality (AOR 2.52, 95 % CI 1.86-3.41), prolonged LOS by 4.8 days (95 % CI 4.0-5.5), and increased hospitalization costs by $27,600 (95 % CI $24,400-30,900).
Despite growing SAE utilization, its failure rate remains stable with FE being associated with inferior clinical and financial outcomes. Improve patient selection, increased availability of embolization and providing early embolization in select cases may enhance SAE outcomes.
在美国，近45%的腹部钝性创伤病例存在脾损伤（BSI），近年来脾动脉栓塞术（SAE）越来越多地用于治疗BSI。然而，SAE失败后需要延迟脾切除术仍然是一个关键问题，对患者预后和医疗资源利用有重大影响。
我们利用2016 - 2021年全国再入院数据库进行了一项回顾性队列研究。纳入接受SAE或脾切除术的成年（≥18岁）BSI患者。早期栓塞定义为入院后48小时内进行SAE。SAE失败（FE）定义为在首次住院期间或出院后30天内SAE未成功后进行脾切除术。建立多变量回归模型以评估FE与住院死亡率、住院时间（LOS）和费用的关联。
在44750例纳入患者中，17921例（40.0%）最初采用SAE作为手术方法。在研究期间，栓塞失败率保持稳定（2016年：8.1%对2021年：9.4%，nptrend = 0.86），FE后的死亡率也是如此（2016年：1.9%对2021年：1.3%，nptrend = 0.05）。经过风险调整后，早期栓塞与FE几率降低相关（调整后比值比[AOR] 0.78，95%置信区间[CI] 0.64 - 0.95）。FE与死亡率几率显著增加相关（AOR 2.52，95% CI 1.86 - 3.41），LOS延长4.8天（95% CI 4.0 - 5.5），住院费用增加27600美元（95% CI 24400 - 30900美元）。
尽管SAE的应用越来越多，但其失败率保持稳定，FE与较差的临床和经济结果相关。改善患者选择、增加栓塞的可及性并在特定病例中提供早期栓塞可能会改善SAE的结果。
