Abstract

Background

The long-term treatment trends of splenic injuries can provide guidance when treating trauma patients. The nonoperative management (NOM) of splenic injuries was introduced in early 1989. After decades of development, it has proven to be safe and is now the primary treatment choice worldwide. However, there remains a lack of nationwide registry data to support the feasibility and efficiency of NOM.

Methods

We used the Taiwan National Health Insurance Research Database to conduct a whole population-based cohort study. Patients admitted with blunt splenic injuries from 2002 to 2013 were identified. Demographic data, management methods, associated injuries, comorbidities and outcome parameters were collected. Patients were divided into 2 groups by the type of admitting institution: a tertiary center or a non-center hospital. We also used 4 years as an interval to analyze the changes in epidemiological data and treatment trends. Comparisons of the results of NOM and surgical management were also performed.

Results

A total of 12,455 patients were admitted with blunt splenic injuries between 2002 and 2013. Among the 11,551 patients treated in a single hospital after admission, patients underwent NOM more frequently at tertiary centers than at non-center hospitals (64.6% vs 50.3%). During the 12-year study period, the NOM rate increased from 56 to 73% in tertiary centers, while in noncenter hospitals, the rate only increased from 43 to 58%. The mortality rate decreased in tertiary centers from 8.9 to 7.2%, with no apparent change in noncenter hospitals. Complications occurred more frequently in the surgical management group.

Conclusion

There is a trend toward the use of NOM for blunt splenic injury treatments, and the outcomes from the NOM groups were not inferior to those of the operation group. In addition, tertiary centers performed more NOM than did non-center hospitals and better met the international consensus.

Details

Title
Hospital level variations in the trends and outcomes of the nonoperative management of splenic injuries – a nationwide cohort study
Author
Liao, Chien-An 1 ; Wu, Yu-Tung 1 ; Liao, Chien-Hung 1 ; Wang, Shang-Yu 1 ; Fu, Chih-Yuan 1 ; Hsieh, Chi-Hsun 1 ; Chen, Shao-Wei 2 ; Chen, Ching-Chang 3 ; Chou, An-Hsun 4 ; Cheng, Chi-Tung 5   VIAFID ORCID Logo 

1  Chang Gung Memorial Hospital, Linkou, Division of Trauma and Emergency Surgery, Department of Surgery, Taoyuan City, Taiwan (GRID:grid.454211.7) (ISNI:0000 0004 1756 999X) 
2  Chang Gung Memorial Hospital, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Taoyuan City, Taiwan (GRID:grid.454210.6) (ISNI:0000 0004 1756 1461) 
3  Chang Gung University, Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan (GRID:grid.145695.a) 
4  Chang Gung University, Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan (GRID:grid.145695.a) 
5  Chang Gung Memorial Hospital, Linkou, Division of Trauma and Emergency Surgery, Department of Surgery, Taoyuan City, Taiwan (GRID:grid.454211.7) (ISNI:0000 0004 1756 999X); Chang Gung University, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan (GRID:grid.145695.a); National Yang-Ming University, Institute of Biomedical Informatics, Taipei, Taiwan (GRID:grid.260770.4) (ISNI:0000 0001 0425 5914) 
Pages
4
Publication year
2019
Publication date
Dec 2019
Publisher
Springer Nature B.V.
ISSN
17577241
e-ISSN
15007480
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s13049-018-0578-y
ProQuest document ID
2788430969
Copyright
© The Author(s). 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.