World J Surg (2021) 45:2027–2036

https://doi.org/10.1007/s00268-021-06063-x

SCIENTIFIC REVIEW

Post-traumatic Splenic Injury Outcomes for Nonoperative

and Operative Management: A Systematic Review
Sabrina Gill1 • John Hoff1 • Ashley Mila1 • Carol Sanchez1 • Mark McKenney1,2 • Adel Elkbuli1

Accepted: 28 February 2021 / Published online: 8 April 2021

Ó Société Internationale de Chirurgie 2021

Abstract
Background Splenectomies are widely performed, but there exists controversy regarding care for splenic injury
patients. The purpose of this study is to provide a comprehensive review of the literature over the last 20 years for
operative management (OM) versus nonoperative management (NOM) versus splenic artery embolization (SAE) for
traumatic splenic injuries and associated outcomes.
Methods A review of literature was performed following the PRISMA guidelines through a search of PubMed,
EMBASE, Cochrane Library, JAMA Network, and SAGE journals from 2000 to 2020 regarding splenic injury in
trauma patients and their management. Articles were then selected based on inclusion/exclusion criteria with
GRADE criteria used on the included articles to assess quality.
Results Twenty retrospective cohorts and one prospective cohort assessed patients who received OM versus NOM or
SAE. Multiple studies indicated that NOM, in properly selected patients, provided better outcomes than its operative
counterpart.
Conclusion This review provides additional evidence to support the NOM of splenic injuries for hemodynamically
stable patients with benign abdomens as it accounts for consistently shorter hospital length of stay, fewer compli-
cations, and lower mortality than OM. For hemodynamically unstable patients, management continues to be inter-
vention with surgery. More studies are needed to further investigate outcomes of post-splenectomy patients based on
grade of injury, hemodynamic status, type of procedure (i.e., SAE), and failure of NOM in order to provide additional
evidence and improve outcomes for this patient population.

Background hemorrhagic shock or instability while the remainder

Splenic injuries are prevalent in abdominal trauma [1]. In
the USA, 10% to 15% of traumatic splenic injury patients
will have an immediate splenectomy usually for
& Adel Elkbuli
adel.elkbuli@hcahealthcare.com
1
Department of Surgery, Division of Trauma and Surgical
Critical Care, Kendall Regional Medical Center, 11750 Bird
Road, Miami, FL 33175, USA
2
Department of Surgery, University of South Florida, Tampa,
FL, USA
undergo nonoperative management (NOM) [2]. NOM for
minor splenic injuries has been associated with several
advantages with the goal of preserving the spleen [1]. The
spleen serves an important role in protection from certain
infectious diseases [3]. Alternatives to splenectomies have
also been considered in instances in which the patient is
marginally stable or has a high-grade injury. Included in
these other procedures is splenic artery embolization (SAE)
[1].
Although there is a vast amount of research on traumatic
splenic injuries, there is limited recent research on which
management options for traumatic splenic injuries have

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improved outcomes. The purpose of this study is to review
the recent literature and evaluate the outcomes of different
types of traumatic splenic injury management. We
hypothesize that NOM or SAE, in properly selected
patients, would lead to improved outcomes (i.e., mortality,
hospital length of stay (HLOS), and complications) in
comparison with operative management (OM).
Objectives
The purpose of this study is to review the current literature
to provide guidance for the management of traumatic
splenic injuries and outcomes. Splenectomy is an appro-
priate management strategy for some types of splenic
injury; gaps in our knowledge exist, which include the
following: type of management (OM vs. NOM vs. SAE).
Multiple variables including type of injury (blunt vs. pen-
etrating), grade of splenic injury, hemodynamic status, and
surgeon preferences have made evaluating this topic by
prospective evidence exceedingly difficult. Our objective is
to summarize the literature in regard to patient presenta-
tions, possible interventions, and outcomes.
Population, intervention, comparator, and outcome
PICO 1
Is OM versus NOM associated with better outcomes in a
select population of patients?
PICO 2
Is SAE associated with better outcomes in a select popu-
lation of patients?
Methods
Data sources and search strategy
The Preferred Reporting Items for Systematic Reviews and
Meta-Analyses (PRISMA) was referenced for this study.
The databases searched included: PubMed, EMBASE,
Cochrane Library, JAMA Network, and SAGE journals. A
literature search was performed to find articles on post-
traumatic splenic injuries from January 2000 to August 30,
2020 (Fig. 1). The following search terms were used:
splenectomy AND trauma injuries OR splenic injury,
nonoperative management AND splenic trauma, splenec-
tomy outcomes AND nonoperative management.
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World J Surg (2021) 45:2027–2036
Study selection and eligibility criteria
There were no limitations for sample size, patient age, or
follow-up. Inclusion criteria were: (1) blunt or penetrating
traumatic spleen injury, (2) cohort, case–control, or clinical
trial, (3) splenic injury at baseline or as dependent/inde-
pendent variable, (4) must include at least one of the fol-
lowing outcomes: HLOS, complication rate, and mortality
rate, (5) must include hemodynamic status of patient
population, and (6) must have NOM or splenectomy
management utilized in the study. Studies were excluded
based on the following criteria: (1) no specified type of
traumatic splenic injury, (2) NOM or splenectomy man-
agement not used, (3) systematic reviews, case reports,
case series, editorials, and review articles, (4) no data for
HLOS, complication rate, and/or mortality rate, and (6)
lack of hemodynamic status of patients. Each study was
assessed using the GRADE Working Group criteria. SAE
was defined as a therapeutic intervention that was distin-
guished from NOM [2]. The search was restricted to arti-
cles in English language or studies translated to English.
Data collection process
Authors JJH, AMM, and SG performed the initial literature
search followed by a second and final search by all authors.
JJH, SG, CS and AMM screened articles for inclusion and
performed the data extraction under supervision by AE and
MM. The measured outcomes included HLOS, mortality,
and complication rate.
Study selection and assessment of quality of evidence
The initial database review identified 2089 articles (Fig. 1).
A critical appraisal yielded 21 studies utilized in this
review (Tables 1, 2) [4–24]. Twenty retrospective cohorts
[4–18, 20–24], one prospective cohort [19] assessed
patients who received OM, NOM, or SAE due trauma
[4–24]. Totally, 12,974 patients were included in the 21
selected studies. The quality of evidence of the studies
included in this review using GRADE guidelines were
moderate for OM versus NOM (PICO 1) as well as for SAE
(PICO 2) (Table 3).
Results
OM versus NOM
Hemodynamically stable OM and stable NOM
There were no studies that only reported hemodynamically
stable patients for both OM and NOM (not including SAE).
World J Surg (2021) 45:2027–2036 2029

Fig. 1 Flow diagram of studies

included in this review

Identification
Records identified through
database searching
2000-2020
(n = 2089)

Screening
Records after duplicates
removed
(n = 1607)

Full-text articles excluded:

Eligibility

Full-text articles assessed

for eligibility not a cohort, case-control,
(n = 21) or RCT; no outcomes
reported (n = 1586)
Included

Studies included in
systematic review
(n = 21)

Hemodynamically unstable OM and unstable NOM
There were no studies that only reported hemodynamically
unstable patients for both OM and NOM (not including
SAE).
Hemodynamically stable NOM and unstable OM
There were nine retrospective cohort studies that compared
hemodynamically stable NOM and unstable OM. [4–12]
Scarborough found that HLOS was 7 days for NOM and 10
for OM (p \ 0.001) [4]. Teuben found no difference in
patients younger than 17 HLOS between OM and NOM
(p = 0.638) [5]. In contrast, Saraubh found that HLOS in
the OM group was 12.8 days versus 8.3 days in the NOM
(p = 0.005) [6]. A retrospective cohort conducted by Heuer
also found that the HLOS was significant between the two
groups (31.4 days vs. 28.7 days, p \ 0.05) for OM and
NOM, respectively [7]. Additionally, a 10-year retrospec-
tive study done in Ontario (1992–2001) found that the
median HLOS was longer for OM versus NOM (21 days
vs. 14, p \ 0.001) [8]. In terms of mortality, the rate was
similar between operative and nonoperative groups (9.3%
v. 6.8%, p = 0.49). [8] Jesani, found a similar mortality for
OM and NOM (including SAE), which was 13% and 7%
(p = 0.4), respectively. This study also reported 17 out of
36 splenectomy patients were stable, and all the patients
who underwent NOM were initially stable. [9] Mortality
rate was higher for OM than NOM in another study;
however, they also had higher grade of splenic injury [10].
Evaluation of complications in both hemodynamically
stable and unstable patients shows a mixed picture.
Cadeddu found complications were similar between
groups, 47.9% versus 37.9% for OM versus NOM
(p = 0.13) [8]. Studies by Spijkerman and Zurita found no
significant differences in complications between OM and
NOM [11, 12]. Complications from Spijkerman included
intra-abdominal infection, sepsis pneumonia, ileus, multi-
organ dysfunction syndrome, wound infection continued
bleeding, and re-bleeding [11]. Furthermore, Zurita repor-
ted four left pleural effusions, three abdominal collections,
one evisceration, and no hemoperitoneum as complications
but these were more likely secondary to the trauma itself
rather than the intervention being compared [11, 12].

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 Table 1 Blut and penetrating trauma studies evaluating splenectomy outcomes grouped by search categories
2030

First author, Population Follow-up Study design Mechanism N Per arm Arm Injury Mortality Hospital Complications

123
year of injury Severity LOS
Score (ISS) (days)

Operative versus nonoperative management (including embolization)

Jesani et al., Adult N/A Retrospective Trauma— 126 67 NOM 13%
2020 [9] cohort blunt (including
SAE)
54 Splenectomy 7%
5 SAE
Spijkerman Adult N/A Retrospective Trauma— 118 45 Splenectomy 25 (19–36) 7 8 (7–2) 19
et al., 2017 cohort penetrating 51 Spleen- 18 (13–25) 0 7 (5–12) 9
[11] preserving
surgical
therapy
22 NOM 27 (18–41) 0 8 (5–15) 4
Scarborough Adult N/A Retrospective Trauma— 2,746 1,489 NOM 34 (26–42) 93 (6.3%) 7 (5–13) 191 (12.8)
et al., cohort blunt
2016 [4] 1,257 Operative 34 (26–42) 207 (16.5%) 10 (6–20) 294 (23.4)
Bruce et al., Adult N/A Retrospective Trauma— 41 30 SAE 15.6 ± 6.5 0% (0) 5.7 ± 3.7 6.5% (2)
2011 [13] cohort blunt
11 Surgery 15.6 ± 7.5 13.3% (2) 7.7 ± 4.1 20.0% (3)
Teuben et al., Pediatrics N/A Retrospective Trauma— 62 52 OM 36 (23–45) 1 12 3
2020 [5] (Up to cohort blunt
17 years
of age)
10 NOM 16 (9–18) 0 9 6
Gross et al., Pediatrics N/A Retrospective Trauma— 259 17 Splenectomy 4 18.5
2013 [23] (18 years cohort blunt
and
younger)
15 SAE 0 12
227 Observation 3 6.5
Chastang Adult Once/month until Prospective Trauma— 91 22 Surgery 24.5 17 15 (68%)
et al., 2015 resumption of cohort blunt 54 NOM 16 12 16 (29%)
[19] normal activities
15 SAE 16.3 11 10 (67%)
and one year after
discharge
Guinto et al., Adult N/A Retrospective Trauma— 1052 996 Splenectomy 34.5 29.7% 9 (3–20) 8.9% (organ
2020 [16] cohort blunt [25.0–45.0] space
infections)
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 Table 1 continued
First author, Population Follow-up Study design Mechanism N Per arm Arm Injury Mortality Hospital Complications
year of injury Severity LOS
Score (ISS) (days)

56 SAE 34.0 17.9% 10.5 (5–25) 3.0% (organ

[22.0–43.0] space
infections)
Cadeddu Adult N/A Retrospective Trauma— 266 118 OM 78.8% [ 25 11 25 47.9%
et al., 2006 cohort blunt (12.5–51)
[8]
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148 NOM 40.5% [ 25 10 10 (6–18) 37.9%

Wahl et al., Adult N/A Retrospective Trauma— 60 36 Splenectomy 35 ± 12 8 (22%) 19 ± 17 11
2004 [22] cohort blunt
24 SAE 27 ± 11 2 (8%) 14 ± 15 3
Smith N/A Retrospective Trauma— 221 56 OM 4
et al.,2006 Cohort Blunt
[21]
Adult 124/165 Non-op— Ten failure of
expectant expectant
management
41/165 Non-op— 0 Eleven failure of
EMBO embo
management
Duchesne Adult N/A Retrospective Trauma— 154 78 Splenectomy 31 ± 13 18% 5% ARDS
et al., 2008 cohort blunt
[14]
76 SAE 29 ± 11 15% 22% ARDS
Wei et al., N/A Retrospective Trauma— 92 37 OM 34 ± 12 2 14 ± 10 Abdominal
2008 [15] cohort blunt complications:
13
Adult 55 SAE 29 ± 11 4 12 ± 12 Abdominal
complications:
2
2031

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2032 World J Surg (2021) 45:2027–2036

Splenic artery embolization (SAE)

Complications
Hemodynamically stable OM and stable SAE

There were three retrospective cohort studies that com-

pared hemodynamically stable OM and stable SAE.
Hospital

[13–15] Overall, the outcomes for SAE compared to

(days)
LOS

splenectomies are mixed. Bruce utilized only hemody-

namically stable patients in this retrospective study [13].
15

9 When assessing the outcomes that were analyzed in this

review, this study did not find significant differences in
Mortality

HLOS and complications [13]. Duchesne found no differ-

ence in mortality between splenectomy and SAE (18% vs.
12

15%) but SAE has an increased complication rate (22% vs.

5%, p = 0.002) [14]. Likewise, Wei found no difference in
Score (ISS)

mortality or HLOS between OM and SAE despite the SAE

Severity

group being older and having a higher Abbreviated Injury

Injury

Scores (AIS) but SAE was associated with lower compli-

27

21

86

cations (p \ 0.01). [15]

1991–1998:

1998–2005:

Hemodynamically unstable OM and unstable SAE

NOM

NOM
Arm

OM

OM

One retrospective cohort study compared hemodynami-

cally unstable OM and unstable SAE. [16] The study uti-
136 (SAE

344 (SAE
Splenic
salvage

salvage
splenic
Per arm

125)

354)

lized a retrospective cohort and found that SAE patients

136,

344,

had a significantly higher incidence of organ space infec-

86

59

tions than splenectomy patients (8.9% vs. 3.0%, p = 0.02)

[16].
623
N

Hemodynamically stable SAE and unstable OM

Mechanism

Trauma—
of injury

blunt

There were eight retrospective cohort studies that com-

pared hemodynamically stable SAE and unstable OM.
[17–24] HLOS was 7 versus 11 days, and 14.7% versus
Retrospective
Study design

26.4% complications for SAE versus splenectomies,

cohort

respectively (p \ 0.001 for both) [17]. Similarly, a study

by Frandon showed SAE provided a significantly lower
HLOS compared to splenectomy, 14.4 days versus 23,
p = 0.003) [18].
SAE was found in one prospective study to be associ-
ated with a higher morbidity than surgery. They followed
these patients up to one year after hospital discharge. This
Follow-up

study reported 91 patients, 8 unstable patients under

N/A

immediate splenectomy. The group that later underwent

SAE had higher spleen related complications than the
group handled by NOM and OM (47%, 10% and 15%,
Population

respectively, p = 0.02). [19] In contrast, a study by Rosati

Adult

found that mortality rate was highest for splenectomy

Table 1 continued

patients at 25% [20]. In another study on adult patients,

there were four deaths in the group of patients who
Rajani et al.,
First author,

2006 [24]

underwent splenectomy compared to zero deaths in

patients who had SAE. They concluded that SAE offers a
year

safe solution when observation fails in these patients [21].

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 Table 2 All cause trauma studies evaluating splenectomy outcomes grouped by search categories
First author, year Population Study design Mechanism of N Per Arm Injury Severity Score Mortality Hospital Complications
injury arm (ISS) LOS (days)
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Operative versus nonoperative management (including embolization)

Saurabh et al. 2011 Adult Retrospective Trauma—all 67 42 NOM 11.9 7–22 (9.9)
[6] cohort cause 25 Splenectomy 20.12 7–26 (12.8)
Heuer, et al., 2010 Adult Retrospective Trauma—all 1630 872 NOM 36.5 22.20% 28.7
[7] cohort cause 758 Splenectomy 41.6 24.80% 31.4
Rosati et al.,2015 Adult Retrospective Trauma—all 926 120 Immediate 36.1 (± 1.3) 25% 14.9 (Infection)
[20] cohort cause splenectomy (± 1.4) 16.7%
129 Embolization 29.1 (± 1.0) 3.90% 10.1 (± .9) 10.90%
677 Observations/ 21.6 (± 0.5) 6.50% 9.7 (± .6) 9.20%
angiography
Aiolfi et al., 2017 Adult Retrospective Trauma—all 4,063 461 SAE 25 (19–30) 24 (5.2%) 7 (4–12) 65 (14.7%)
[17] cohort cause 3,602 Splenectomy 29 (22–41) 447 11 (7–20) 870 (26.4%)
(11.6%)
Bagaria et al., 2019 Adult Retrospective Trauma—all 129 95 NOM 0% 5.0 (3.0)
[10] cohort cause 34 OM 5.88% 6.0 (4.0)
Frandon et al., Adult Retrospective Trauma—all 136 61 NOM 16 (14.5–24) 0 (0.0%) 10 (8–14) 20 (32.79%)
2015 [18] cohort cause 50 NOM with SAE 20 (16–25) 0 (0.0%) 14 (11–19) 31 (62.0%)
25 OM 37 (28.5–43) 4 (16.0%) 15 24 (96.0%)
(10–21.5)
Zurita et al., 2019 Adult Retrospective Trauma—all 110 38 Splenectomy 22.4 7
[12] cohort cause 56 NOM 17.6 1
16 Spleen-preserving 29 2
surgery
All cause trauma is defined as a combination of blunt and penetrating injury
2033

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Table 3 Quality assessment using GRADE criteria
Number Study design Limitations Inconsistency
of studies
Operative vs nonoperative (including embolization)
21 Observational Not serious No
inconsistency
1 Heterogeneity among
study PICO
questions
2 Large variation in
effect
3 Small sample size
Amongst the operative vs non-operative PICO there are no serious reasons to possibly rate down the quality of evidence and therefore the
evidence remains at a ‘‘low’’ quality due to the baseline of observational studies. Amongst the vaccination PICO there are both small sample
sizes and serious heterogeneity amongst the studies enough to rate down the quality of evidence and therefore the evidence is downgraded to a
‘‘very low’’ quality
The results by Aiolfi found that the mortality for splenec-
tomy patients was no different from SAE [17]. A different
study utilized SAE for hemodynamically stable patients
and those who were not stable went to the operation room.
It was concluded that patient selection for SAE is crucial
for successful management. Failure rates in both SAE and
NOM were associated with increasing injury grade. Of the
patients who underwent SAE, there were no failures in
patients with injuries grade 1–2, and approximately 40%
with grade 3–5 [21].
Wahl reported specifically that 11 patients who were
hemodynamically unstable were sent directly for a
splenectomy while the remaining 153 patients were stable.
After adjusting for confounders, there were no significant
differences in mortality for patients who underwent SAE
versus OM (4% vs. 8%) [22]. In another study comparing
SAE to splenectomy, splenectomy was the initial treatment
of choice for hemodynamic instability and stable patients
underwent SAE. SAE has been found to be safe and
effective alternative to splenectomy in pediatric patients,
specifically those that are 18 and younger [23]. Blood
transfusion was significantly different with the SAE group
and OM (40% of children vs. 88%).[23] Additionally,
Rajani concluded that the use of SAE as well as NOM can
increase splenic salvage and provide improved outcomes
[24].
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Indirectness Imprecision Other considerations Quality of
evidence
No serious No serious No upgrades from baseline Moderate
indirectness imprecision observational ‘‘Low’’ evidence ss
In accordance with GRADE criteria
standards, observational studies without
special strengths or important limitations
provide low-quality evidence at baseline
Discussion
Assessment of splenic injury patients is important in
determining the appropriate management. Typically,
immediate OM is utilized for hemodynamic instability
while NOM and SAE is reserved for hemodynamically
stable patients [5, 18, 24–26]. One study mentioned that
SAE was selected if there was active extravasation of
contrast [23]. This selection bias could provide reasoning
that multiple studies concluded that NOM has better mor-
tality rates and shorter HLOS [4, 6–8]. It was also dis-
covered that there was no difference in complications in
select studies despite differences in hemodynamic stability
[11, 12, 18]. Beuran noted that the criteria for NOM were
no rebound/guarding, age \ 55 years, no lack of con-
sciousness, blood transfusions B 4 units, and hemody-
namic stability or readily stabilized [25]. This same study
also reports favorable outcomes including low morbid-
ity/mortality and decreased HLOS [25].
There was also extensive variation in the outcomes of
certain patients treated with SAE compared to OM [26].
Some studies reported less complication rates, and others
found increased complications [14–17, 19]. One study
reported a significantly lower mortality with SAE but as is
typical, the patients were different at baseline [20]. These
findings generally support SAE in hemodynamically
stable patients with extravasation or high-grade injuries
World J Surg (2021) 45:2027–2036
[17]. However, its use in hemodynamic instability is con-
troversial. The injury grading system no longer has a large
impact on chosen intervention in traumatic splenic injury
the way that hemodynamic status does; however, physio-
logically, higher grade is usually associated with more
hemodynamic instability [26]. In six studies, SAE revealed
to have significantly better outcomes than OM.
[15, 17, 18, 20, 23, 24] Our investigation also reveals that
NOM can be utilized in splenic injuries given hemody-
namic stability. NOM has been safely used in low-grade
splenic injuries in hemodynamically stable patients but also
has been shown to be safe in high-grade splenic injuries in
this same patient population [26, 27]. However, clinical
judgment should always be part of the decision making
process.
When compared to another review that investigated OM
and NOM for blunt splenic trauma, it was found that NOM
was a superior treatment for minor splenic injuries. [1]
Although the authors were only able to assess mortality
rates for 3 of 21 articles [1], in comparison, our review was
able to account for mortality rate in 9 of the 21 articles
showing mortality rate improvement with OM (5 vs. 4
studies).
Guidelines have been developed for treating patients
with traumatic splenic injury. The current guidelines by the
Eastern Association for the Surgery of Trauma (EAST)
suggest laparotomy if a patient has diffuse peritonitis or is
hemodynamically unstable due to abdominal trauma. NOM
continues to be the treatment choice for hemodynamically
stable patients [28]. The Western Trauma Association
(WTA) management of splenic trauma corresponds with
guidelines from EAST [29]. Hemodynamic stability
remains an important deciding factor between OM and
NOM, which is also supported by this review.
Recommendations
This investigation has provided a comprehensive review
about the usage and applicability of OM, NOM, and SAE.
It shows and reinforces that NOM and SAE can be utilized
in hemodynamically stable patients. OM has been shown to
be the most common choice of management for hemody-
namically unstable patients. According to the EAST
guidelines for blunt splenic injury, patients who have dif-
fuse peritonitis or who are hemodynamically unstable after
blunt abdominal trauma should be taken urgently for
laparotomy [28]. This recommendation is mostly based on
data from 2003 and a landmark trial by Pachter et al., in
1998. The EAST recommendations also state that the
severity of splenic injury, neurologic status, age [ 55 and/
or the presence of associated injuries are not contraindi-
cations to a trial of NOM in a hemodynamically
stable patient [28]. The World Society of Emergency
2035
Surgery (WSES) recommendations are similar to the EAST
recommendations and are in line with the findings in this
review. In the WSES recommendations, the injuries are
divided into mild, moderate, and severe. Patients with
severe injuries who are hemodynamically unstable are
recommended to undergo operative management. Of note,
operative management is also recommended in pediatric
patients with severe splenic lesions [30]. Although more
data are needed, this study supports both the EAST and
WSES guidelines in which a routine laparotomy is not
indicated in the hemodynamically stable patient without
peritonitis presenting with an isolated splenic injury.
Because these guidelines exist, there is limited data on
NOM of hemodynamically unstable patients and so our
recommendations remain in line with the current guideli-
nes, which recommend operative intervention for hemo-
dynamically unstable patients.
Limitations
Our review comes with limitations. A total of 21 articles
met the study inclusion criteria; however, more research is
needed to provide additional evidence-based recommen-
dations regarding current clinical guidelines and practices.
Baseline characteristics varied among selected studies,
which could affect the generalizability of results and/or
recommendations. Some studies did not clarify how the
management was chosen, which is another difficulty faced
with retrospective studies. Lastly, among the studies that
compared OM to NOM and SAE, there was limited
information included in the review on patients who failed
NOM and SAE.
Conclusion
This review provides additional evidence to support the
NOM of splenic injuries for hemodynamically stable pa-
tients with benign abdomens as it accounts for consistently
shorter hospital length of stay, fewer complications, and
lower mortality than OM. For hemodynamically unsta-
ble patients, management continues to be intervention with
surgery. More studies are needed to further investigate
outcomes of post-splenectomy patients based on grade of
injury, hemodynamic status, type of procedure (i.e., SAE),
and failure of NOM in order to provide additional evidence
and improve outcomes for this patient population.
Author contributions AE contributed to study design and concep-
tion. SG, JH, AM, AE, CS, and MM contributed to data collection,
analysis, and interpretation. SG, JH, CS, AM, MM, and AE con-
tributed to manuscript preparation. SG, AE, MM, JH, AM, and CS
123
2036
contributed to critical revisions of manuscript. All authors approved
the final version of manuscript.
Funding None.
Compilance with ethical standards
Conflict of interest Authors declare no competing interests.
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