Article

Hospital factors associated with splenectomy for splenic injury: a national perspective.

The University of Texas Health Sciences Center at Houston, Houston, Texas. USA.
The Journal of trauma (impact factor: 2.48). 12/2004; 57(5):1065-71. pp.1065-71
Source: PubMed

ABSTRACT The management of patients with splenic injury has shifted from routine splenectomy to attempts at splenic salvage. Using the Healthcare Cost and Utilization Project's National Inpatient Sample (HCUP-NIS), we assessed the patterns of care for splenic trauma. We hypothesized that the processes of care in urban and rural hospitals would differ.
Generalized estimating equations were used to identify predictor variables associated with laparotomy and splenectomy from a national, population-based sample of inpatients (HCUP-NIS). Fourteen thousand nine hundred one patients with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code of 865 were selected from the 1998 to 2000 HCUP-NIS data. Exclusion criteria included age greater than 80 years. Analyses were compared using all patients and excluding patients who died during the first 2 hospital days.
Eight thousand five hundred fifty-three patients were treated in urban teaching hospitals. Forty percent underwent a laparotomy and 28% underwent a splenectomy at that time. Another 4,461 patients were cared for in urban nonteaching hospitals. Of these, 46% had a laparotomy and 35% underwent a splenectomy. The remaining 1,887 patients were seen in rural hospitals. Forty-six percent had a laparotomy and 36% had a splenectomy. Patients in urban teaching hospitals had lower risk-adjusted odds of splenectomy in multivariate models controlling for confounders including overall injury severity. Overall splenic salvage increased from 1998 to 2000, primarily because of increased salvage rates among urban teaching hospitals.
The management of patients with splenic injury differs among urban teaching, urban nonteaching, and rural hospitals. Surgeons at urban teaching hospitals appear more willing to attempt splenic salvage by means of nonoperative management.

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Keywords

2000 HCUP-NIS data
 
attempt splenic salvage
 
attempts
 
Clinical Modification discharge diagnosis code
 
first 2 hospital days
 
Healthcare Cost
 
International Classification
 
multivariate models
 
national
 
Ninth Revision
 
predictor variables
 
remaining 1,887 patients
 
routine splenectomy
 
salvage rates
 
splenic injury
 
splenic salvage
 
splenic trauma
 
urban nonteaching
 
urban nonteaching hospitals
 
Utilization Project's National Inpatient Sample