Splenic artery embolization versus surgery for blunt splenic injuries: a systematic review, meta-analysis and trial sequential analysis stratified by hemodynamic status.

In 30 seconds

This systematic review and meta-analysis compared splenic artery embolization (SAE) with surgery in adults with blunt splenic injuries, using randomized and nonrandomized studies and examining outcomes by hemodynamic status. Across 33 148 patients, SAE was associated with lower mortality than surgery (RR: 0.43; 95% CI: 0.25-0.72; p = 0.004). It was also associated with shorter hospital and intensive care stays and less thromboembolism. In the subgroup of hemodynamically unstable patients, SAE was likewise associated with lower mortality (RR: 0.47; 95% CI: 0.29-0.75; p = 0.014).

Key findings

• Among 33 148 patients, mortality was lower with SAE than surgery (RR: 0.43; 95% CI: 0.25-0.72; p = 0.004).
• In hemodynamically unstable patients, SAE was associated with lower mortality (RR: 0.47; 95% CI: 0.29-0.75; p = 0.014).
• SAE was associated with reduced hospital and intensive care length of stay (MD: -3.1; p = 0.015 and MD: -4; p = 0.024, respectively).
• Thromboembolism risk was lower following SAE (RR: 0.58; 95% CI: 0.47-0.70; p = 0.0008); additional complications did not differ.

Why it matters

The findings suggest that SAE may be associated with better survival and fewer thromboembolic events than surgery, including among patients classified as hemodynamically unstable. This challenges the assumption that surgery is necessarily the preferred approach for all unstable patients and provides comparative evidence relevant to ongoing discussion of trauma management. Because the evidence includes observational studies, the associations should not be interpreted as proof of a treatment effect.

What to keep in mind

The review included observational studies and heterogeneous populations, with potential confounding by indication.