Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database study
Abstract Purpose This study aimed to identify risk factors for rebleeding within 180 days post-discharge in blunt splenic injury patients managed without splenectomy or embolization. Materials and methods A retrospective analysis was conducted using Taiwan’s National Health Insurance Research Databa...
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| Format: | Article |
| Language: | English |
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BMC
2025-02-01
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| Series: | World Journal of Emergency Surgery |
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| Online Access: | https://doi.org/10.1186/s13017-025-00586-7 |
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| author | Chung-Yen Chen Hung-Yu Lin Pie-Wen Hsieh Yi-Kai Huang Po-Chin Yu Jian-Han Chen |
| author_facet | Chung-Yen Chen Hung-Yu Lin Pie-Wen Hsieh Yi-Kai Huang Po-Chin Yu Jian-Han Chen |
| author_sort | Chung-Yen Chen |
| collection | DOAJ |
| description | Abstract Purpose This study aimed to identify risk factors for rebleeding within 180 days post-discharge in blunt splenic injury patients managed without splenectomy or embolization. Materials and methods A retrospective analysis was conducted using Taiwan’s National Health Insurance Research Database. Adult patients aged ≥ 18 years with blunt splenic injury (ICD-9-CM codes 865.01–865.09) from 2000 to 2012 were included. Patients who died, underwent splenectomy (ICD-9-OP codes 41.5, 41.42,41.43, and 41.95) or transcatheter arterial embolization (TAE) (ICD-9-OP codes 39.79 and 99.29) on the first admission were excluded. The primary endpoint was rebleeding, which was identified if patients underwent splenectomy or TAE at 180 days after discharge. Multivariate logistic regression was used to identify risk factors, which were validated in a separate cohort. Results Of 6,140 patients, 80 (1.302%) experienced rebleeding within 180 days. Five significant risk factors were identified: age < 54 years (aOR 3.129, p = 0.014), male sex (aOR 2.691, p = 0.010), non-traffic accident-induced injury (aOR 2.459, p = 0.006), ISS ≥ 16 (aOR 2.130, p = 0.021), and congestive heart failure (aOR 6.014, p = 0.006). We generate Delayed Splenic Bleeding System (DSBS). Patients with > 2 points had significantly higher rebleeding rates (risk-identifying cohort: 2.2% vs. 0.6%, OR 3.790, p < 0.001; validation cohort: 2.6% vs. 0.8%, OR 3.129, p = 0.022). Conclusions Age < 54 years, male, non-traffic accident-induced injury, ISS ≥ 16, and congestive heart failure are risk factors of rebleeding within 180 days after discharge from treating blunt splenic injury without splenectomy or embolization. Despite limitations, this study underscores large-scale data’s role in identifying risks which can aid clinicians in prioritizing additional interventions during NOM. |
| format | Article |
| id | doaj-art-439ee0ffcb9b4eac955d0740b2cac476 |
| institution | Kabale University |
| issn | 1749-7922 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | World Journal of Emergency Surgery |
| spelling | doaj-art-439ee0ffcb9b4eac955d0740b2cac4762025-02-09T12:26:26ZengBMCWorld Journal of Emergency Surgery1749-79222025-02-0120111110.1186/s13017-025-00586-7Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database studyChung-Yen Chen0Hung-Yu Lin1Pie-Wen Hsieh2Yi-Kai Huang3Po-Chin Yu4Jian-Han Chen5Division of General Surgery, Department of Surgery, E-Da HospitalSchool of Medicine, College of Medicine, I-Shou UniversityDivision of General Surgery, Department of Surgery, E-Da HospitalDivision of General Surgery, Department of Surgery, E-Da HospitalDivision of General Surgery, Department of Surgery, E-Da HospitalDivision of General Surgery, Department of Surgery, E-Da HospitalAbstract Purpose This study aimed to identify risk factors for rebleeding within 180 days post-discharge in blunt splenic injury patients managed without splenectomy or embolization. Materials and methods A retrospective analysis was conducted using Taiwan’s National Health Insurance Research Database. Adult patients aged ≥ 18 years with blunt splenic injury (ICD-9-CM codes 865.01–865.09) from 2000 to 2012 were included. Patients who died, underwent splenectomy (ICD-9-OP codes 41.5, 41.42,41.43, and 41.95) or transcatheter arterial embolization (TAE) (ICD-9-OP codes 39.79 and 99.29) on the first admission were excluded. The primary endpoint was rebleeding, which was identified if patients underwent splenectomy or TAE at 180 days after discharge. Multivariate logistic regression was used to identify risk factors, which were validated in a separate cohort. Results Of 6,140 patients, 80 (1.302%) experienced rebleeding within 180 days. Five significant risk factors were identified: age < 54 years (aOR 3.129, p = 0.014), male sex (aOR 2.691, p = 0.010), non-traffic accident-induced injury (aOR 2.459, p = 0.006), ISS ≥ 16 (aOR 2.130, p = 0.021), and congestive heart failure (aOR 6.014, p = 0.006). We generate Delayed Splenic Bleeding System (DSBS). Patients with > 2 points had significantly higher rebleeding rates (risk-identifying cohort: 2.2% vs. 0.6%, OR 3.790, p < 0.001; validation cohort: 2.6% vs. 0.8%, OR 3.129, p = 0.022). Conclusions Age < 54 years, male, non-traffic accident-induced injury, ISS ≥ 16, and congestive heart failure are risk factors of rebleeding within 180 days after discharge from treating blunt splenic injury without splenectomy or embolization. Despite limitations, this study underscores large-scale data’s role in identifying risks which can aid clinicians in prioritizing additional interventions during NOM.https://doi.org/10.1186/s13017-025-00586-7Blunt splenic injuryRebleeding risk predictionNon-operative managementTranscatheter arterial embolizationSplenectomy |
| spellingShingle | Chung-Yen Chen Hung-Yu Lin Pie-Wen Hsieh Yi-Kai Huang Po-Chin Yu Jian-Han Chen Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database study World Journal of Emergency Surgery Blunt splenic injury Rebleeding risk prediction Non-operative management Transcatheter arterial embolization Splenectomy |
| title | Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database study |
| title_full | Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database study |
| title_fullStr | Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database study |
| title_full_unstemmed | Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database study |
| title_short | Risk factors of 180-day rebleeding after management of blunt splenic injury without surgery and embolization: a national database study |
| title_sort | risk factors of 180 day rebleeding after management of blunt splenic injury without surgery and embolization a national database study |
| topic | Blunt splenic injury Rebleeding risk prediction Non-operative management Transcatheter arterial embolization Splenectomy |
| url | https://doi.org/10.1186/s13017-025-00586-7 |
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