A. Grigorian1, M. Lekawa1, V. Joe1, S. D. Schubl1, T. Chin1, A. Kong1, J. Nahmias1 1University of California, Irvine,Surgery,Orange, CA, USA
Introduction: Geriatric trauma patients (GTP) (age≥65 years) with blunt splenic injury (BSI) have up to a 6% failure rate of non-operative management (NOM). GTPs failing NOM have a similar mortality rate compared to GTPs managed successfully with NOM. It is unclear if there is a linear relationship with mortality in patients ≥ 65-years old presenting with blunt splenic injury and undergoing NOM. We hypothesized the failure rate for NOM in octogenarians (aged 80-89 years) would be similar to patients aged 65-79 years, and risk of mortality in octogenarians who fail NOM to be higher than octogenarians managed successfully with NOM.
Methods: The Trauma Quality Improvement Program (2010-2016) was queried for patients with BSI. Those undergoing splenectomy within 6-hours were excluded to select for patients undergoing NOM. Two groups were compared: age 65-79 vs. 80-89. A multivariable logistic regression model was used to determine risk for failed NOM and mortality.
Results: From 43,041 NOM BSI patients, 3,600 (8.5%) were aged 65-79 and 1,236 (2.9%) were 80-89. Both groups had a similar median injury severity score (ISS) (p=0.10) and failure rate of NOM (6.6% age 65-79 vs. 6.8% age 80-89 p=0.82). From those failing NOM, octogenarians had similar units of blood products transfused (p>0.05), however, a higher mortality rate (40.5% vs. 18.2%, p<0.001), compared to patients aged 65-79. Independent risk factors for NOM failure in octogenarians included ≥ 1 unit of packed red blood cells (PRBC) (p=0.039) within 24-hours of admission. Octogenarians that failed NOM had a higher mortality rate compared to octogenarians managed successfully with NOM (40.5% vs 23.6% p=0.001), which remained after adjusting for severe ISS (OR 2.25, CI 1.37-3.70, p<0.001). Late failure of NOM ≥ 24 hours (vs. early failure) was not associated with increased risk of mortality (p=0.88) but ≥ 1 unit of PRBC transfused had higher risk (OR 1.88, CI 1.20-2.95, p=0.006).
Conclusion: Compared to patients aged 65-79 with BSI, octogenarians have a similar rate of failed NOM. Octogenarians with BSI who fail NOM have over a two-fold higher risk of mortality compared to those managed successfully with NOM. One or more units of PRBC transfused increase risk for mortality. Late failure of NOM did not increase risk of mortality in octogenarians with BSI.
