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

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.