Nonoperative treatments like splenic angioembolization show better outcomes than surgery for severe blunt splenic injuries.

• Morbidity is significantly lower with splenic angioembolization (odds ratio 0.61) and observation (odds ratio 0.71) compared to open splenectomy.
• Among hypotensive patients, there’s no mortality difference, but angioembolization and observation shorten hospital stays by about 1.4 days each.

Careful patient selection can favor nonoperative management strategies to optimize recovery and minimize complications.