Salvaging the spleen shows lower mortality and complications than splenectomy in severe blunt splenic injuries for trauma patients.

• Mortality risk for splenic angioembolization (0.62) and observation (0.61) is significantly lower than for open splenectomy.
• Both angioembolization and observation have fewer complications compared to splenectomy, with odds ratios of 0.74 and 0.75, respectively.

Spleen preservation should be prioritized, even for hypotensive patients, since the failure of nonoperative management is linked to more complications.