A PROSPECTIVE ANALYSIS OF OPERATIVE VERSUS NON-OPERATIVE MANAGEMENT OF GRADE III SPLENIC INJURY: OUTCOMES AND EFFICACY IN TRAUMA CARE

Abstract

Background: The spleen is the most commonly injured solid organ in blunt abdominal trauma. While splenectomy was historically the mainstay, non-operative management (NOM) has gained prominence in hemodynamically stable patients. This study compares the efficacy and outcomes of NOM and operative strategies in Grade III splenic injuries.

Methods: A prospective observational study was conducted in the Department of General Surgery, Saveetha Medical College (January 2022–January 2025). Thirty adult patients with radiologically confirmed Grade III splenic injury (AAST classification) were enrolled. Patients were managed based on hemodynamic status: 18 underwent NOM, while 12 required operative intervention. Data on demographics, transfusion needs, complications, hospital stay, spleen preservation, and mortality were analyzed using appropriate statistical tests, with p <0.05 considered significant.

Results: Spleen preservation was significantly higher in the NOM group (83.3%) compared to the operative group (16.6%) (p<0.001). The mean hospital stay was shorter in NOM patients (5.3 ± 1.2 days) versus operative patients (8.2 ± 1.8 days, p=0.002). Blood transfusion requirement (>2 units) was markedly lower in NOM patients (16.6%) than operative patients (75%, p=0.01). Complications occurred in 5.5% of NOM patients versus 41.6% in operative cases (p=0.03). NOM failed in 3 patients (16.6%) who later required surgery. Thirty-day mortality was 0% in the NOM group and 16.6% in the operative group (p=0.04).

Conclusion: NOM is safe and effective for hemodynamically stable Grade III splenic injuries, offering higher spleen preservation, fewer complications, and no observed mortality compared to operative management. Surgery should be reserved for unstable patients or failed NOM. Larger multicentric studies are warranted to refine selection criteria and establish standardized management algorithms.