Title

Impact of Splenic Injury Guidelines on Hospital Stay and Charges in Patients with Isolated Splenic Injury

Document Type

Article

Publication Date

10-2009

Abstract

Background

The purpose of this study was to assess the impact of care guidelines for patients with isolated blunt splenic trauma on length of stay (LOS) and patient charges.

Methods

We conducted a review of the hospital trauma registry and identified patients admitted with blunt splenic injury from 2000 to 2007. Splenic injury guidelines were initiated in November 2004. Patients with other major injuries were excluded. Patients were grouped according to their American Association for the Surgery of Trauma (AAST) splenic injury grade, I–V. Hospital LOS, intensive care unit (ICU) LOS, and patient charges before and after the guidelines were compared.

Results

We identified 137 patients with isolated splenic injuries. Sixty-three patients were admitted before and 70 patients after implementation of the guidelines. ICU and hospital LOS were significantly decreased after the guidelines (ICU LOS, 1.35 days before, 0.80 after [P < .01]; and hospital LOS, 4.17 before, 3.27 after [P < .01]). When grouped by AAST grade, grade II injuries had a decrease in hospital LOS (4.5 before vs 2.29 after; P < .01) and ICU LOS (1.43 before vs 0.29 after; P < .01). Adjusted hospital charges showed no significant increase overall after the guideline implementation (mean hospital charges before $23,047 vs after, $24,116; P = .62).

Conclusion

Implementing guidelines for the observation of blunt splenic injury decreased the overall hospital LOS and ICU LOS at our institution, but hospital charges remained the same. Trauma programs should institute splenic injury guidelines to reduce resources needed for the care of isolated splenic injuries.

The treatment of blunt splenic injury has evolved substantially over the last 50 years. King and Shumacker first characterized overwhelming post-splenectomy infection in 1952, reporting 2 deaths in 5 infants who had splenectomy for spherocytosis. In 1969, Upadhyaya and Simpson reviewed 52 children with splenic injury and would later suggest that nonoperative management of blunt splenic injury might be feasible.Over the next decade, splenectomy was replaced by partial splenectomy, splenorrhaphy, and nonoperative management in many instances. The later introduction of splenic angioembolization provided an additional option for splenic preservation. Nonoperative management guidelines are still being studied

DOI

10.1016/j.surg.2009.06.021