Abstract：
BACKGROUND: Venous thromboembolism (VTE) continues to be a major cause of morbidity in trauma. It is unclear whether the type of hemorrhage control procedure (i.e., splenectomy versus angioembolization) is associated with an increased risk of VTE. We hypothesize that hemodynamically stable patients undergoing angioembolization for blunt high-grade splenic injuries have lower rates of VTE compared to those undergoing splenectomy.
METHODS: The American College of Surgeons Trauma Quality Program dataset from 2017 to 2019 was queried to identify all patients with American Association for the Surgery of Trauma grade 3-5 blunt splenic injuries. Outcomes including VTE rates were compared between those who were managed with splenectomy versus angioembolization. Propensity score matching (1:1) was performed adjusting for age, sex, initial vital signs, Injury Severity Score, and splenic injury grade.
RESULTS: The analysis included 4698 matched patients (splenectomy [n = 2349] and angioembolization [n = 2349]). The median (interquartile range) age was 41 (27-58) years and 69% were male. Patients were well matched between groups. Angioembolization was associated with significantly lower VTE than splenectomy (2.2% versus 3.4%, P = 0.010) despite less use of VTE chemoprophylaxis (70% versus 80%, P < 0.001), as well as a relative delay in initiation of chemoprophylaxis (44 h versus 33 h, P < 0.001). Hospital and intensive care unit length of stay and mortality were also significantly lower in the angioembolization group.
CONCLUSIONS: Angioembolization is associated with a significantly lower incidence of VTE than splenectomy. Thus, angioembolization should be considered for initial management of hemodynamically stable patients with high-grade blunt splenic injuries in whom laparotomy is not otherwise indicated.
METHODS: The American College of Surgeons Trauma Quality Program dataset from 2017 to 2019 was queried to identify all patients with American Association for the Surgery of Trauma grade 3-5 blunt splenic injuries. Outcomes including VTE rates were compared between those who were managed with splenectomy versus angioembolization. Propensity score matching (1:1) was performed adjusting for age, sex, initial vital signs, Injury Severity Score, and splenic injury grade.
RESULTS: The analysis included 4698 matched patients (splenectomy [n = 2349] and angioembolization [n = 2349]). The median (interquartile range) age was 41 (27-58) years and 69% were male. Patients were well matched between groups. Angioembolization was associated with significantly lower VTE than splenectomy (2.2% versus 3.4%, P = 0.010) despite less use of VTE chemoprophylaxis (70% versus 80%, P < 0.001), as well as a relative delay in initiation of chemoprophylaxis (44 h versus 33 h, P < 0.001). Hospital and intensive care unit length of stay and mortality were also significantly lower in the angioembolization group.
CONCLUSIONS: Angioembolization is associated with a significantly lower incidence of VTE than splenectomy. Thus, angioembolization should be considered for initial management of hemodynamically stable patients with high-grade blunt splenic injuries in whom laparotomy is not otherwise indicated.
摘要：
背景：静脉血栓栓塞（VTE）仍然是创伤发病的主要原因。目前尚不清楚出血控制程序的类型(即，脾切除术与血管栓塞术）与VTE风险增加相关。我们假设，与接受脾切除术的患者相比，接受血管栓塞治疗钝性高级别脾损伤的血流动力学稳定的患者的VTE发生率较低。
方法：查询了2017年至2019年美国外科医生学会创伤质量计划数据集，以确定美国3-5级钝性脾损伤手术协会的所有患者。比较了接受脾切除术和血管栓塞治疗的患者的结果，包括VTE率。倾向评分匹配(1:1)进行年龄调整，性别,初始生命体征,伤害严重程度评分,和脾损伤等级。
结果：分析包括4698例匹配患者（脾切除术[n=2349]和血管栓塞[n=2349]）。中位（四分位间距）年龄为41（27-58）岁，69％为男性。患者之间匹配良好。血管栓塞与VTE显著低于脾切除术(2.2%对3.4%,P=0.010），尽管使用了较少的VTE化学预防（70％对80％，P<0.001)，以及开始化学预防的相对延迟（44h对33h，P<0.001)。血管栓塞组的住院时间和重症监护病房住院时间和死亡率也明显较低。
结论：血管栓塞术与VTE的发生率明显低于脾切除术。因此，对于高度钝性脾损伤的血流动力学稳定的患者,初始治疗应考虑血管栓塞治疗,其中不需要进行剖腹手术.
方法：查询了2017年至2019年美国外科医生学会创伤质量计划数据集，以确定美国3-5级钝性脾损伤手术协会的所有患者。比较了接受脾切除术和血管栓塞治疗的患者的结果，包括VTE率。倾向评分匹配(1:1)进行年龄调整，性别,初始生命体征,伤害严重程度评分,和脾损伤等级。
结果：分析包括4698例匹配患者（脾切除术[n=2349]和血管栓塞[n=2349]）。中位（四分位间距）年龄为41（27-58）岁，69％为男性。患者之间匹配良好。血管栓塞与VTE显著低于脾切除术(2.2%对3.4%,P=0.010），尽管使用了较少的VTE化学预防（70％对80％，P<0.001)，以及开始化学预防的相对延迟（44h对33h，P<0.001)。血管栓塞组的住院时间和重症监护病房住院时间和死亡率也明显较低。
结论：血管栓塞术与VTE的发生率明显低于脾切除术。因此，对于高度钝性脾损伤的血流动力学稳定的患者,初始治疗应考虑血管栓塞治疗,其中不需要进行剖腹手术.
