Artikel
Impact of splenectomy on early neurological outcome in patients with traumatic brain injury
Einfluss der Splenektomie auf den frühen neurologischen Zustand von Patienten mit Schädelhirntrauma
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Autoren
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Marius Mader
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Rolf Lefering
- Universität Witten/Herdecke, Institut für Forschung in der Operativen Medizin, Köln, Deutschland
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Marc Maegele
- Klinikum Köln-Merheim, Universität Witten/Herdecke, Klinik für Orthopädie, Unfallchirurgie und Sporttraumatologie, Köln, Deutschland
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Patrick Czorlich
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Inflammation is an important component of secondary brain injury after traumatic brain injury (TBI). Besides a local immune response, systemic inflammatory reaction seems to contribute to further cerebral injury. Splenectomy has been associated with a suppression of proinflammatory cascades as well as improved survival and cognitive function in animal models of TBI. Aim of this study was to elucidate the effect of splenectomy on early neurological outcome in trauma patients with TBI.
Methods: A retrospective cohort analysis of patients treated between 2008 and 2017 registered in the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) was conducted. Inclusion criteria were ≥16 years of age, an Injury Severity Score (ISS) ≥16, Abbreviated Injury Scale (AIS) Head ≥3 and an abdominal injury. Primary outcome parameter was favorable early neurologic outcome defined as a Glasgow Outcome Scale of 4 or 5 at discharge. A multivariable logistic regression analysis was performed to adjust for confounding factors and assess the independent effect of splenectomy.
Results: The study cohort consisted of 2669 patients meeting the inclusion criteria. Among the included patients, 329 (12.3%) received a splenectomy, 785 (29.4%) had a splenic injury but were not splenectomized and 1555 (58.3%) had no injury to the spleen. Head injury was more severe in patients with splenectomy (AIS Head 5&6 24.3% vs 21.6%). Patients with splenectomy demonstrated a higher ISS (Mean±SD: 46.5±11.7 vs 36.4±12.6) and hypotension was more frequent at admission (36.9% vs 21.6%). Crude neurological outcome at discharge was favorable in 51.5% of splenectomized patients and in 62.9% of patients without splenectomy. Mortality was 20.7% and 11.4% in the splenectomy and non-splenectomy group, respectively. The regression analysis demonstrated no statistically significant effect of splenectomy on favorable early neurological outcome (Odds ratio 0.913 (95% confidence interval 0.674–1.236), p=0.555).
Conclusion: Patients who underwent splenectomy were more severely injured and exhibited a worse prognosis. A positive impact of splenectomy on early neurological outcome was not detectable in the presented retrospective analysis of a TR-DGU cohort. A possible beneficial effect might be too small to influence prognosis in polytraumatic patients and corresponding complex injury patterns.
