Combined splenectomy and nephrectomy for trauma: morbidity, mortality, and outcomes over 30 years.

ABSTRACT

BACKGROUND: Spleen and kidney injuries carry mortality rates of 23% and 26%, respectively. When the magnitude of injury mandates simultaneous splenectomy and left nephrectomy, outcomes are unknown. The goals were to (1) identify the incidence of early morbidity and mortality among these patients and (2) compare these outcomes with those from the era preceding damage control and abdominal compartment syndrome therapies. METHODS: Injured patients who underwent a concurrent splenectomy and left nephrectomy at Grady Memorial Hospital (GMH, 1995-2007) were compared with those at Ben Taub (BT, 1978-1987). RESULTS: Thirty-five and 30 patients underwent concurrent splenectomy and left nephrectomy at BT and GMH, respectively. Demographics, mortality (43% and 53%), and morbidity (79% and 81%) at BT and GMH were similar over a 3-decade span (p > 0.05). Deaths were typically due to refractory hemorrhage within 24 hours of admission to both centers (73% and 56%, p > 0.05). Despite advances in antimicrobials and drainage, 38% and 33% of patients developed a left subphrenic abscess. Associated injury pattern, splenic and renal injury grade, and blood loss were also consistent across centers (p > 0.05). More GMH patients presented with blunt mechanisms (33% vs. 14%) and associated injuries (4.1 vs. 2.4 per patient, p < 0.05). CONCLUSIONS: The overall mortality associated with concurrent splenectomy and left nephrectomy approximates 43% to 53%. This has not changed despite a nearly 30-year timeframe and is still primarily related to refractory hemorrhagic shock. The complication rate of 80% is also consistent and is predominantly composed of left subphrenic abscesses and multiorgan failure.