EGS P03 Selective non-operative management of high grade splenic injuries is safe in both the short and long term

Abstract Background Blunt and penetrating splenic injuries represent a significant component of the workload in major trauma centres in the UK. International guidelines recommend intervention for patients suffering high grade injuries. This single centre retrospective cohort study assessed current management of adults with splenic injuries, stratified by World Society of Emergency Surgery (WSES) classification, and compared this to the recommended management proposed by the WSES guidelines. Methods Patients admitted between April 2014 to January 2021 to a major trauma centre with splenic injuries were prospectively assessed. Data on AAST grade, WSES class, radiological imaging, definitive interventions performed, length of admission, follow-up imaging and short and long-term outcome were collected. Results 143 patients with splenic injuries were admitted during the study period. 5 patients were excluded due to inadequate clinical information. 138 patients with splenic injury were analysed. 50 suffered WSES grade 1 injuries, 25 WSES grade 2, 18 WSES grade 3 and 45 WSES grade 4. Patients with WSES grade 3 and 4 injuries were managed as follows: conservative 13, angioembolisation 38 and splenectomy 12. Length of stay did not differ between groups. No patient undergoing non-operative management required salvage splenectomy. One patient undergoing angioembolisation required laparoscopic drainage of splenic abscess secondary to infarction. During the study period 4 patients died (2.7)%. The cause of death in each case was due to other injuries. Long term imaging follow up was organised in 31 patients undergoing angioembolisation. 30 patients (97%) had imaging features suggestive of perfused splenic tissue. Conclusions Conservative management of splenic injuries with the addition of angioembolisation for high grade injuries led to a splenectomy rate of less than 10% in this study. This strategy led to low morbidity with only one patient requiring subsequent intervention and no splenic injury related mortality. This study validates the increasing trend towards non-operative management for splenic injuries.