Traumatic splenic injury in the elderly population: Does management choice affect outcome?

Purpose Trauma within older people is increasingly recognised as a different entity, with different management and outcomes to younger people. We aim to compare the 30-day survival and length of stay of splenic injury patients in English major trauma centres in an elderly trauma (65+) cohort in comparison to under 65. Methods Data were obtained from the Trauma Audit Research Network of all Grade 2–5 American Association of Surgery in Trauma (AAST) splenic injuries admitted to English Major Trauma Centres between 01/01/17 and 31/12/21. End-points of mortality and length of stay were compared between the under 65 and 65+ groups according to treatment using descriptive statistics and multi-variable regression analysis. Results In total, 802/3958 (20.2%) of admissions were 65+ and 2926/3958 (73.9%) were male. The proportion of AAST grades 3–5 was 41.3% (331/802) for 65+ and 52.3% (1652/3156) for under 65. A total of 12.8% (103/802) received embolisation in the 65+ group and 13.1% (413/3156) within the under 65 group. In total, 6.9% (55/802) in the 65+ group received splenectomy compared to 10.1% (319/3156). Within the 65+ group, 30-day mortality in the splenectomy group was 14.5% (8/55) compared to embolisation (18/103, 17.5%) and conservative (141/644, 21.9%). The 30-day mortality was (10.3%, 33/319) in those having a splenectomy as first treatment in the under 65's, compared with embolisation (26/413, 6.3%) and conservative management (197/2424, 8.1%). Embolisation failure was 3.9% (4/103) in the 65+ group and 7.3% (30/413) in the under 65 group. Splenectomy is associated with an increased length of stay at 1.20 (confidence interval (CI) 1.06, 1.37) times longer; however, this was not affected by age group. Conclusion Mortality was higher in the under 65 cohort regardless of treatment. Splenectomy is associated with an increased length of stay compared to embolisation, however there is no clear interaction demonstrated between age and first treatment.