Ventilator-Associated Pneumonia in Trauma Patients with Splenic Injuries: Does Splenectomy Increase the Risk?

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BACKGROUND: The impact of splenectomy on immune function and infection risk in trauma patients remains debated. Severely ill trauma patients are known to have a high risk for ventilator-associated pneumonia (VAP). We hypothesize that trauma patients undergoing splenectomy do not have a higher incidence of VAP compared with those managed with splenic preservation. PATIENTS AND METHODS: We conducted a retrospective review of trauma registry data for patients admitted with splenic injuries from 2017 to 2023. Exclusions included patients who died within 48 h, had an Injury Severity Score (ISS) <25, or required <3 ventilator days. Only patients admitted to the surgical intensive care unit (ICU) with confirmed splenic injuries were included. The American Association for the Surgery of Trauma splenic injury scale was used to grade injury severity. VAP was defined per the 2024 National Trauma Data Standard by the American College of Surgeons. We collected data on ISS, Abbreviated Injury Scale for chest, abdomen-pelvis, and head, demographics, hospital, ICU length of stay, ventilator days, mechanism of injury, microbiology, vaccination status, and splenic injury grade. Patients were stratified into splenectomy and splenic preservation groups, which included embolization, splenorrhaphy, or observation. VAP incidence was compared across groups. RESULTS: Among 140 patients, 64 (46%) underwent splenectomy, and 76 (54%) had splenic preservation. Uni-variable analysis showed higher VAP rates in the splenic preservation group (32.9% vs. 18.8%), but this was not statistically significant (p = 0.059). Multi-variable regression confirmed that longer ventilator days increased VAP risk (OR: 1.13, p < 0.001). Splenectomy itself was not associated with a higher VAP incidence (OR: 0.42, p = 0.054). CONCLUSION: In this study, splenectomy was not substantially associated with VAP, whereas prolonged ventilator duration remained the strongest predictor. Larger studies are needed to clarify whether splenectomy influences pneumonia risk.

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