The real risk of splenectomy after discharge home following nonoperative management of blunt splenic injury.

Background: The postdischarge natural history of nonoperative blunt splenic injury (BSI) has not been adequately elucidated. As a result, outpatient management is poorly defined. Population-based outpatient data would provide clinicians with an estimate of baseline risk of postdischarge splenectomy after nonoperative management of BSI. The purpose of this study was to analyze, using population-based data, the 180-day risk of splenectomy in a clinically relevant sample.

Methods: A statewide Hospital Discharge Data System containing patient level data was used to construct a prospective cohort of persons 18 or older with nonoperatively managed BSI admitted to any hospital in the state from 2000 to 2005 and discharged home. Re-admission for splenectomy within 180 days from the original injury date was analyzed.

Results: Four thousand one hundred three persons with BSI were admitted from 2000 to 2005. Two thousand nine hundred seventy-one (72.4%) were managed nonoperatively. One thousand nine hundred thirty-two (47.1%) were discharged. Twenty-seven of 1,932 were re-admitted for splenectomy within 180 days. Median time from injury to re-admission for splenectomy was 8 days (range, 3-146). The 180-day risk of splenectomy was 1.4% after nonoperative management and discharge home.

Conclusions: Nonoperative management of BSI results in a 180-day risk of re-admission for splenectomy of 1.4% for persons discharged home. A majority of splenectomies occur within 8 days. Explicit patient education and close follow-up are necessary.