Risk factors for splenic injury during colectomy: A matched case-control study

Purpose: We assessed risk factors for splenic injury during colectomy and associated outcomes for a 15-year period at a single institution. Methods: All adult general surgery patients who sustained a splenic injury during colectomy at our institution from 1992 to 2007 were retrospectively identified and matched 1:1 to controls without splenic injury. Putative risk factors were assessed using paired univariate analysis and conditional logistic regression. Differences in short- and long-term mortality were assessed using the log-rank test. Results are reported as a proportion, median, or odds ratio [OR (95% confidence intervals)]. Results: A total of 118 patients were included: 59 patients with splenic injury and 59 control patients. Statistically significant risk factors for splenic injury during colectomy found on univariate analysis included: splenic flexure mobilization, OR 21.00 (2.82-156.12); Charlson comorbidity index ≥ 5, OR 3.17 (1.26-7.93); ASA class ≥ 3, OR 5.33 (1.55-18.3); and nonelective surgery, OR 5.00 (1.1-22.82). On multivariate analysis, only splenic flexure mobilization was independently associated with increased risk of splenic injury (OR 18.4 (2.1-161); p = 0.0085). Splenic injured patients trended toward decrease survival both at 30 days (98 vs. 88%; p = 0.06) and at 5 years (58 vs. 55%), with a hazard ratio of 1.6 (1.0, 2.6; p = 0.05). Conclusions: Splenic flexure mobilization is the primary risk factor for splenic injury during colectomy, independent of other factors, such as higher ASA class, Charlson score, and nonelective surgery. Splenic injury during colectomy has an increased risk of death in both the short- and long-term.