Research Reports - Splenectomy in patients with traumatic brain injury: protective or harmful?
J Trauma Acute Care Surg. 2013 Oct;75(4):596-601
Teixeira PG, Karamanos E, Okoye OT, Talving P, Inaba K, Lam L, Demetriades D
BACKGROUND: Experimental data have demonstrated a potential survival benefit for
animals undergoing splenectomy immediately after traumatic brain injury. The aim
of this study was to investigate the effect of splenectomy on survival in
patients with moderate or severe traumatic brain injury (TBI).
METHODS: This is a National Trauma Data Bank (2002-2009) analysis and included
patients sustaining moderate or severe blunt head trauma (head Abbreviated Injury
Scale [AIS] score, 3-5), with an associated splenic injury and an exploratory
laparotomy. The population was divided into two arms: those that had a
splenectomy and those who did not. The primary outcome was in-hospital mortality.
Logistic regression was performed to adjust for factors that were significantly
different between the study groups.
RESULTS: During the 9-year study period, 2,625 patients met the criteria for
inclusion in the analysis. Of these, 1,450 (55%) had a splenectomy, and 1,175
(45%) did not. Mortality was 13% for the splenectomized compared with 9% for the
nonsplenectomized population (p = 0.001). After logistic regression, mortality
remained significantly higher in the splenectomized population (adjusted odds
ratio [AOR], 1.62; 95% confidence interval [CI], 1.16-2.26; p = 0.005). After
stratification according to the severity of brain injury, the association between
splenectomy and increased mortality persisted for both patients with moderate
head injury (8% vs. 6%; AOR, 2.43; 95% CI, 1.26-4.71; p = 0.008) and for patients
with severe head injury (17% vs. 10%; AOR, 1.49; 95% CI, 1.03-2.19; p = 0.036).
CONCLUSION: Splenectomy was independently associated with increased mortality in
patients with moderate or severe TBI. This finding warrants further investigation
regarding splenic preservation in patients with TBI.
LEVEL OF EVIDENCE: Therapeutic study, level IV.