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Citation
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Warnack E, Bukur M, Frangos S, DiMaggio C, Kozar RA, Klein M, Berry C. Am. J. Surg. 2020; ePub(ePub): ePub. |
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Affiliation
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NYU School of Medicine/Bellevue Hospital, NYU School of Medicine Department of Surgery, 462 First Avenue, NY, 10016, USA. Electronic address: Cherisse.Berry@nyulangone.org. |
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Abstract
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BACKGROUND: While the incidence of geriatric trauma continues to increase, the management of high-grade blunt splenic injury (BSI) in the elderly remains controversial. Among this population, data evaluating survival rates following non-operative and operative management are inconsistent. We analyzed mortality risk in geriatric patients with high-grade BSI based on operative vs. non-operative management.
METHODS: A retrospective analysis of the National Trauma Database identified patients with isolated, high-grade (AIS ≥ 3) BSI from 2014 to 2015. Patients were stratified into three groups: non-elderly (<65 years), elderly (65-79 years), and advanced age (80 years and older). Each age group was stratified into three management groups: non-operative (including embolization), initial operative management (OR within 24 h), and failed non-operative management. Patient characteristics and outcomes were compared. Multivariable logistic regression estimated association with mortality.
RESULTS: 5560 patients with isolated, high-grade BSI were identified. In the group that failed NOM, mortality was 2% in non-elderly patients, versus 22.2% in elderly patients and 50% in patients of advanced age (p < .01). In this group, patients over 80 years old spent an average of 6.5 days longer in the ICU vs. non-elderly patients (median 10.5 days, IQR [6.75, 19.5] vs. 4 days, IQR [3,6], p = 0.02). In patients with isolated, high grade BSI, age was independently associated with mortality (AOR 1.02; p < 0.01). Elderly patients who required surgery were over three times more likely to die (AOR 3.39; p < 0.01). Advanced age patients who required surgery were over eight times more likely to die (AOR 8.1; p < 0.01).
CONCLUSIONS: For patients with BSI, age is independently associated with death in both operative and non-operative cases.
Copyright © 2020 Elsevier Inc. All rights reserved.
Language: en |