Search

Importance: Splenectomy is a commonly performed operation; however, data from large series regarding operative outcomes to help guide decision making and informed consent are lacking., Objective: To evaluate clinical and pathologic variables associated with morbidity and mortality following elective splenectomy for benign and malignant hematologic conditions in the United States., Design, Setting, and Participants: A review of the American College of Surgeons National Surgical Quality Improvement Program data for elective splenectomy between January 1, 2005, and December 31, 2011, was performed, and 1715 eligible individuals were identified., Intervention: Elective splenectomy for hematologic conditions., Main Outcomes and Measures: Complications and operative mortality were evaluated for the entire cohort and compared between patients with benign vs malignant diseases. Multivariable logistic regression was used to evaluate factors predictive of operative complications and death., Results: Splenectomy was performed in 1344 patients (78.4%) for benign disease and in 371 patients (21.6%) for malignant disease. Two hundred ninety-one patients (17.0%) had a complication, and operative mortality occurred in 27 patients (mortality rate, 1.6%). Patients treated for malignant disease had a higher rate of overall complications (27.2%) compared with patients treated for benign disease (14.1%) (P < .001). Several variables were independent predictors of complications, including malignant disease (vs benign) (Odds Ratio [OR], 1.86; 95% CI, 1.23-2.80; P = .003), independent performance status (vs dependent) (OR, 0.33; 95% CI, 0.07-1.52; P = .02), and increasing albumin level (OR, 0.75; 95% CI, 0.66-0.86; P < .001). Increasing age (OR, 1.03; 95% CI, 1.00-1.06; P = .05) was an independent predictor of mortality while increasing albumin level (OR, 0.63; 95% CI, 0.46-0.86; P = .003) predicted lower risk of operative death. From these data, a patient older than 60 years with a low preoperative albumin level has a predicted probability for operative death as high as 10.0%., Conclusions and Relevance: Preoperative performance and nutritional status are significant risk factors for complications and mortality following elective splenectomy. Although operative mortality continues to decrease over time, specific preoperative variables may help with patient selection before elective splenectomy for certain patients.

Background: Splenectomy is performed for a variety of indications in haematological disorders. This study was undertaken to analyse outcomes, and morbidity and mortality rates associated with this procedure., Methods: Patients undergoing splenectomy for the treatment or diagnosis of haematological disease were included. Indications for operation, preoperative risk, intraoperative variables and short-term outcomes were evaluated., Results: From January 1997 to December 2010, 381 patients underwent splenectomy for diagnosis or treatment of haematological disease. Some 288 operations were performed by an open approach, 83 laparoscopically, and there were ten conversions. Overall 136 patients (35·7 per cent) experienced complications. Postoperative morbidity was predicted by age more than 65 years (odds ratio (OR) 1·63, 95 per cent confidence interval 1·05 to 2·55), a Karnofsky performance status (KPS) score lower than 60 (OR 2·74, 1·35 to 5·57) and a haemoglobin level of 9 g/dl or less (OR 1·74, 1·09 to 2·77). Twenty-four patients (6·3 per cent) died within 30 days of surgery. Postoperative mortality was predicted by a KPS score lower than 60 (OR 16·20, 6·10 to 42·92) and a platelet count of 50,000/µl or less (OR 3·34, 1·25 to 8·86). The objective of the operation was achieved in 309 patients (81·1 per cent). The success rate varied for each indication: diagnosis (106 of 110 patients, 96·4 per cent), thrombocytopenia (76 of 115, 66·1 per cent), anaemia (10 of 16, 63 per cent), to allow further treatment (46 of 59, 78 per cent) and primary treatment (16 of 18, 89 per cent)., Conclusion: Splenectomy is an effective procedure in the diagnosis and treatment of haematological disease in selected patients., (© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.)

Background: The hazards of elective splenectomy in the elderly have not been thoroughly investigated. The aim was to assess such a well-defined cohort with respect to perioperative and long-term outcome., Methods: Fifty-two consecutively splenectomised patients during the period 1971-1995, aged 65 years or older, were followed until death (44 cases) or the end of 1999 (8 cases)., Results: No intraoperative deaths occurred, while three patients (5.8%) died postoperatively in the 1970s. Twenty-four patients suffered from thirty-four postoperative complications, dominated by infections and haematomas. No differences were seen comparing patients with and without complications related to the American Society of Anesthesiologists' classes, total transfusion rate, steroid medication, preoperative risk diseases, "giant spleens" or the time period during which the operations were performed. In 69% of the patients, the splenectomy was beneficial. During the long-term follow-up, 25 patients suffered from 59 infectious and thromboembolic episodes and 1 surgical complication. The dominating causes of death were the primary disease (29%), myocardial infarction (20%), sepsis (12%) and cerebrovascular lesions (12%), i.e. not directly related to late effects of the operation., Conclusion: High-risk patients older than 65 years with haematological disorders can safely undergo splenectomy with a low mortality rate and a reasonable rate of morbidity. The long-term course demonstrates a fair response rate, minimal surgically related complications, but thromboembolic and infectious events, and the majority of deaths unrelated to late effects of the splenectomy.

The role of splenectomy in haematological disease appears to be changing. This single centre, retrospective study was carried out to document the indications for splenectomy and its outcome over a 7-year period and to compare it with the preceding 7-year period. Sixty-four patients underwent splenectomy in the study period, the main indication being idiopathic thrombocytopenic purpura. There was one post-operative death and morbidity was seen in 40 (63%) patients. Splenectomy was successful in achieving the desired aim in 51 (80%) patients. Approximately 40% fewer patients underwent splenectomy in the study period compared with the preceding 7 years despite there being an overall increase of 123 (633 vs. 540) patients treated for haematological disease in this period. The reason for this observation was the fall in the number of splenectomies performed for Hodgkin's disease and auto-immune haemolytic anaemia.

A retrospective chart analysis was conducted for all patients undergoing splenectomy for hematologic disorders at the Baptist Hospitals of Louisville between 1970 and 1989. Fifty-nine charts comprise the basis of this review. Variables considered included disease entities treated by splenectomy, indications for splenectomy, and morbidity and mortality associated with the surgery. Additional variables evaluated were splenic weight, estimated blood loss at surgery, technique of splenectomy, and drainage of the splenic bed. The authors found a high correlation of splenic weight to the hematologic disorder treated. Larger spleens were associated with greater blood loss at surgery. Preliminary splenic artery ligation did not reduce the operative blood loss in patients with massive spleens. Drainage of the splenic bed was not associated with postoperative bleeding or intra-abdominal abscess. The low morbidity (22%) and mortality (3.4%) compares favorably to other published studies, demonstrating that splenectomy for hematologic disorders may be safely performed in the community hospital setting.

We report on 106 elective splenectomies performed for haematological disorders between March 1979 and January 1986. The most common indications were immune thrombocytopenic purpura (30 patients) and Hodgkin's disease (19 patients). However, staging laparotomy is no longer performed routinely for patients with Hodgkin's disease and the reasons for this are discussed. Other indications for splenectomy included splenic pain (13 patients), autoimmune haemolytic anaemia (12 patients), hereditary spherocytosis (11 patients) and hypersplenism (9 patients). The overall morbidity and mortality was 48% and 5% respectively. The most common postoperative complication was thrombocytosis (defined as a platelet count greater than 800 X 10(9)/l) and occurred in 26 patients. This review confirms that splenectomy continues to have an important role in the management of certain haematological disorders.

An eight-year experience at Charity Hosptial and Touro Infirmary indicates that 10 percent of splenectomies were performed for reasons other than trauma or malignancy. Fifty-nine per cent of therapeutic splenectomies were done for congenital spherocytosis or idiopathic thromboytopenic purpura. All patients having spherocytosis and 57 per cent having ITP had favorable response following splenctomy. Seven surgical death occurred following 69 splenectomies (mortality 10%). Three deaths were from pulmonary emboli, three from hemorrhagic disorders and one from peritonitis. Eighteen postopertive complications occurred, the most frequent being thromboembolic disease. Prophylactic anticoagulants were not used in any patient.

221 patients were treated by splenectomy for various hematologic disorders, including immunologic thrombocytopenia (80 cases), hereditary spherocytosis (15 cases), immune hemolytic anemia (25 cases), chronic lymphatic leukemia (27 cases), lymphosarcoma (27 cases), myelofibrosis (11 cases) and pancytopenia/aplastic anemia (14 cases). There were 8 postoperative deaths (3.6%), and 49 patients (22%) had postoperative complications, mainly infections and bleeding. Complications were more frequent in cases of massive splenomegaly (greater than or equal to 1 000 g) (65 cases), severe thrombocytopenia (less than 20 X 10(6)/1) (51 cases), and leukemia. Late postsplenectomy fulminant infection was seen in 8 patients (3.6%) for a mean follow up of 5.3 years. We conclude that splenectomy is sufficiently well tolerated even by severely ill patients to make it applicable as a therapeutic modality in the various hematologic disorders presently studied.

Since July 1st, 1958, we have operated 1095 patients with some hematological disease. We review the chief currently accepted surgical indications for splenectomy (Hodgkin's disease no longer being one of them, or seldom so), and we communicate our results pertaining to the immediate postsurgical period. Mortality and morbidity have been 1.36% and 3.28%, respectively. In over 95% of cases, there have been no complications. The low incidence (1.36%) of infection-related complications was partly due to the important number of splenic drains placed. High quality results can only be achieved when tight collaboration exists between hematologists, radiologists and surgeons.

Between 1956 and 1981, 306 splenectomies for hematologic diseases were performed at the UCLA Medical Center. Of these operations, more than 75% were performed for therapeutic reasons to control anemia, thrombocytopenia, neutropenia, or painful symptoms of splenomegaly. Of the 65 patients who had idiopathic thrombocytopenic purpura, 77% showed an excellent response, and of the 39 patients who had hereditary spherocytosis, 90% responded. Other diseases with predictably good response rates were autoimmune hemolytic anemias, Felty's syndrome, and hairy cell leukemia. Forty patients with Hodgkin's disease had splenectomies for diagnostic purposes the last 10 years. The overall morbidity and mortality were 24% and 6%, respectively, the most common complications being pneumonia, wound infections, and local postoperative bleeding, and the most common cause of death being sepsis. The review supports the thesis that in carefully selected patients, therapeutic splenectomy can have desirable palliative effects and that diagnostic splenectomy has a sufficiently low risk to warrant its consideration in patients with Hodgkin's disease.

A comparison between a series of splenectomies performed at the University of Virginia Medical Center for hematologic disorders between 1946 and 1962 (Series I) and 1963 and 1982 (Series II) is presented. Four hundred splenectomies (20 per year) were performed between 1963 and 1982 compared with 94 (5.5 per year) between 1946 and 1962. Also noted in Series II was a sharp decline in the number performed each year between 1974 and 1983. The major factor responsible for these observations was the evolution of the staging laparotomy for malignant lymphomas, particularly Hodgkin's disease, and the decline in the average annual incidence of staging laparotomies since 1974. Staging laparotomy currently is rarely done for non-Hodgkin's lymphomas. Also contributing to the changes noted was an increase in the total number but subsequent fall in the annual incidence of splenectomy for hereditary spherocytosis, idiopathic hypersplenism, and myeloproliferative disorders in Series II. The average number of splenectomies for idiopathic thrombocytopenic purpura increased from 1.1 per year in Series I to 3.6 per year in Series II; the annual incidence during the study period of Series II, however, remained constant. The total number of splenectomies for hairy cell leukemia and Felty's syndrome increased from zero in Series I to 12 and 17, respectively, in Series II, whereas the number of miscellaneous reasons dropped from 29 (1.7 per year) in Series I to 15 (0.75 per year) in Series II. The mortality rate in Series I was 6.3% compared with 4.0% in Series II. No deaths occurred in Series II after 1979. Indications for splenectomy in Series II were for diagnostic purposes in 3.2%, therapeutic in 56.5%, staging in 39.5%, and restaging in 0.8%. Accessory spleens were found in 49 (12.5%) in Series II.

Patients, both adults and children, with various haematological disorders who had splenectomy electively in the diagnosis, staging or treatment of their condition during a 15-year period in the Aberdeen hospitals were reviewed. The outcome regarding the disease and the immediate and long-term complications of splenectomy in this group of 185 patients are presented. Splenectomy has an acceptably low morbidity, even in patients with serious haematological disease, in the hands of an experienced surgical team, where there is close co-operation between surgeon and haematologist. Occasionally, late overwhelming infections may occur, despite prophylaxis with penicillin and pneumococcal vaccination. It seems likely that, in their zeal to report such hazards, authors may allow the pendulum against splenectomy to swing too far, in the direction of leaving patients, especially adults, with considerable symptoms and poor health, rather than risk the occasional consequences of the asplenic state.