No further incidence of sepsis after splenectomy for severe trauma: a multi-institutional experience of the trauma registry of the DGU with 1,630 patients

European Journal of Medical Research

the Trauma Registry of The DGU⁴  S Lendemans²  A Paul⁵  R Lefering³  S Ruchholtz¹  CA Kühne¹  D Nast-Kolb²  GM Kaiser⁵  G Taeger²  M Heuer⁵ 

[1] Department of Trauma Surgery, University Hospital Marburg, Marburg, Germany;Department of Trauma Surgery, University Hospital Essen, Essen, Germany;Institute for Research in Operative Medicine, Faculty of Medicine, University Witten/Herdecke, Campus Cologne-Merheim, Cologne, Germany;German Society for Trauma Surgery (DGU), Committee on Emergency Medicine and Intensive Care;Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Essen, Germany

关键词: mortality;    sepsis;    transfusion;    splenectomy;    splenic injury;    blunt abdominal trauma;   

Others  :  1093107
DOI  :  10.1186/2047-783X-15-6-258

 received in 2009-11-02, accepted in 2009-11-13,  发布年份 2010

【 摘 要 】

Objective

Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure.

Methods

13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score > 16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I) and conservative managed patients (II)).

Results

From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3%) of the patients with splenectomy and 102 (18.5%) without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2%) in both groups. After massive transfusion of red blood cells (> 10) non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40%) and sepsis (38% vs. 25%).

Conclusions

Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3) and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.

【 授权许可】

   
2010 I. Holzapfel Publishers

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