Comparing readmissions and infectious complications of blunt splenic injuries using a statewide database

Authors

Olubode A. Olufajo, Brigham and Women's Hospital , Boston
Arturo Rios-Diaz, Harvard T.H. Chan School of Public Health, Boston
Allan B. Peetz, Brigham and Women's Hospital , Boston
Katherine J. Williams, Brigham and Women's Hospital , Boston
Joaquim M. Havens, Brigham and Women's Hospital , Boston
Zara R. Cooper, Brigham and Women's Hospital , Boston
Jonathan D. Gates, Brigham and Women's Hospital , Boston
Adil H. Haider, Harvard Medical School and Harvard School of Public Health, Brigham and Women's Hospital, BostonFollow
Ali Salim, Brigham and Women's Hospital , Boston
Reza Askari, Harvard T.H. Chan School of Public Health, Boston

Document Type

Article

Department

General Surgery

Abstract

Background: Although non-operative management of blunt splenic injury (BSI) is increasingly common, the long-term infectious complications after adjunct splenic artery embolization (SAE) are not well described.
Methods: Patients aged 18-64 y with BSI were identified in the California State Inpatient Database (2007-2011) and categorized as receiving either non-operative management (NOM) without SAE, NOM with SAE, or operative management (OM). The cumulative incidence of infections (surgical site infections [SSI], pneumonia, urinary tract infections, and sepsis) requiring readmission at different times up to one y after injury were calculated. Patient and treatment factors associated with infectious readmissions were determined using multivariable logistic regression models.
Results: Of the 4,360 patients with BSI, 61.6% had NOM without SAE, 5.8% had NOM with SAE, and 32.6% had OM. The cumulative incidences of infectious complications after each of the management modes were 1.27%, 1.59%, and 1.76%, respectively, during admission (p = 0.446); 2.16%, 5.18%, and 4.85%, respectively, at 30 d after injury (p < 0.001); and 4.69%, 9.16%, and 8.85%, respectively, at one y after injury (p < 0.001). Risk factors for infection-associated readmissions within one y after injury were Charlson score ≥2 (adjusted odds ratio [AOR] 3.9; 95% confidence interval [CI] 2.61-6.02), length of stay >seven d (AOR 2.47; 95% CI 1.58-3.85), NOM with SAE (AOR 2.00; 95% CI 1.19-3.34), and OM (AOR 1.47; 95% CI 1.05-2.07).
Conclusions: The long-term risk of infectious complications in patients with BSI who have NOM with SAE is similar to that in patients who are treated with OM, indicating the need for pro-active strategies to reduce long-term infectious complications after SAE.

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Surgical infections

Recommended Citation

Olufajo, O. A., Rios-Diaz, A., Peetz, A. B., Williams, K. J., Havens, J. M., Cooper, Z. R., Gates, J. D., Haider, A. H., Salim, A., Askari, R. (2016). Comparing readmissions and infectious complications of blunt splenic injuries using a statewide database. Surgical infections, 17(2), 191-197.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/172