Outcomes and costs in splenectomy after failed splenic arterial embolization for blunt splenic injury

TL;DR

This study examines the outcomes and costs of splenectomy after failed splenic artery embolization for treating blunt splenic injuries.

Contribution

The study provides updated data on the failure rate of splenic artery embolization and its impact on mortality, hospital stay, and costs.

Findings

Failed embolization was associated with a 2.52 times higher odds of mortality.

Failed embolization increased hospital stay by 4.8 days and costs by $27,600.

Early embolization reduced the odds of failure by 22%.

Abstract

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.

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•The embolization-first approach for blunt splenic injury has increased from 2016 to 2021.•Embolization failure rate has remained steady over time.•Failed embolization was associated with increased odds of mortality•Failed embolization was associated with incremental hospital duration of stay and costs.•High institutional embolization caseloads were associated with early embolization.

The embolization-first approach for blunt splenic injury has increased from 2016 to 2021.

Embolization failure rate has remained steady over time.

Failed embolization was associated with increased odds of mortality

Failed embolization was associated with incremental hospital duration of stay and costs.

High institutional embolization caseloads were associated with early embolization.

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