S3144 Spleen Preservation Techniques Versus Splenectomy in Traumatic Splenic Injury: A Systematic Review and Meta-Analysis of Clinical Outcomes in Adults

Introduction: Traumatic splenic injuries, often resulting from blunt or penetrating abdominal trauma, pose a critical management dilemma that requires a careful balance between prompt hemorrhage control and preservation of long-term immunologic function. While splenectomy remains standard for unstable patients, spleen-preserving approaches such as nonoperative management, splenic artery embolization, and splenorrhaphy are increasingly favored in stable cases to avoid asplenia-related risks like overwhelming infection. This systematic review and meta-analysis evaluates and compares clinical outcomes between spleen-preservation techniques and splenectomy in adult trauma patients. Methods: A systematic search was performed in PubMed, Embase, MEDLINE, Cochrane Library, and Google Scholar for studies published from 2010 through May 2025. Eligible studies included randomized controlled trials and observational studies comparing spleen-preserving techniques versus splenectomy in adults with traumatic splenic injury. Two reviewers independently extracted data. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a fixed-effects model in RevMan 5.4.1. Primary outcomes included in-hospital mortality, intensive care unit (ICU) length of stay (LOS), and hospital LOS. Secondary outcomes included complication rates, ICU readmissions, and reoperation rates. Results: Nine studies comprising 43,027 patients were included. Spleen-preserving techniques were associated with a reduced risk of in-hospital mortality compared to splenectomy, though this difference was not statistically significant (RR 0.95; 95% CI 0.86-1.06). However, spleen preservation techniques significantly reduced ICU LOS (MD -0.39 days; 95% CI -0.66 to -0.12) and hospital LOS (MD -1.07 days; 95% CI -1.44 to -0.71). Additionally, patients undergoing spleen-preserving treatment had significantly lower complication rates (RR 0.77; 95% CI 0.66-0.90) and ICU readmission rates (RR 0.91; 95% CI 0.85-0.97). No significant difference was observed in reoperation rates (RR 0.86; 95% CI 0.67-1.11). Conclusion: Spleen-preserving techniques in adult trauma patients are associated with significantly fewer complications, shorter ICU and hospital stays, and reduced ICU readmissions, without increased mortality or reoperation risk. Our findings support the use of spleen-preserving strategies in appropriately selected patients, reinforcing their role as a safe and effective alternative to splenectomy.