Nonsurgical management of blunt splenic injury: is it cost effective?

作者：Bruce Pamela J P; Helmer Stephen D; Harrison Paul B; Sirico Tony; Haan James M^*

来源：American Journal of Surgery, 2011, 202(6): 810-815.

DOI：10.1016/j.amjsurg.2011.06.041

• Splenic injury
• Splenectomy
• Splenic embolization
• Cost
• Nonsurgical management

BACKGROUND: This study analyzed outcomes and cost of splenic embolization compared with surgery for the management of blunt splenic injury.
METHODS: We performed a retrospective chart review of all patients admitted with isolated, blunt splenic injury. An intent-to-treat analysis was initially conducted. Outcomes and cost/charges were compared in patients treated with embolization and surgical treatment.
RESULTS: Of 236 patients admitted with isolated, blunt splenic injury, 190 patients were ultimately managed by observation, 31 by splenic embolization, and 15 by surgical management. Comparing outcomes and cost data for splenic embolization versus surgical management, there was no significant difference in intensive care unit use, hospital stay, complications, or re-admission. Surgical management patients required more blood transfusions and incurred higher procedure charges. Conversely, splenic embolization patients underwent more radiologic evaluations and charges. Total procedure-related charges were higher for surgical management when compared with splenic embolization ($28,709 vs $19,062; P = .016), but total hospital cost and total hospital charges were not significantly different.
CONCLUSIONS: Nonsurgical treatment of blunt splenic injury is safe and cost effective. Angioembolization was statistically similar to surgical therapy regarding cost.

• 出版日期2011-12