Is it safe? Nonoperative management of blunt splenic injuries in geriatric trauma patients.

Background: Due to increased failure rates of non-operative management (NOM) of blunt splenic injuries (BSI) in the geriatric population, dogma dictated that this management was unacceptable. Recently, there has been an increased use of this treatment strategy in the geriatric population. However, published data assessing the safety of NOM of BSI in this population is conflicting and well-powered multicenter data is lacking. Methods: We performed a retrospective analysis of data from the National Trauma Data Bank (NTDB) from 2014 and identified young (age = 65) patients with a BSI. Patients who underwent splenectomy within 6 hours of admission were excluded from the analysis. Outcomes were failure of NOM and mortality. Results: We identified 18,917 total patients with a BSI, 2,240 (12%) geriatric patients and 16,677 (88%) young patients. Geriatric patients failed NOM more often than younger patients (6% vs 4%, p=16 was the only independent risk factor associated with failure of NOM in geriatric patients (OR=2.778, CI=1.769 - 4.363, p =16, GCS

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