OUTCOMES OF SPLENECTOMY ON HEMATOLOGIC AND NON-HEMATOLOGIC SPLENIC CONDITIONS
D Tessman, G Liu, J Dewey, S Shebrain, R Sawyer
Western Michigan University
Splenectomy is an important surgical procedure for many splenic conditions. We hypothesized that 30-days post-splenectomy outcomes are different based on surgical indications for splenectomy.
Using the ACS-NSQIP database (2017), patients who underwent splenectomy were identified. The outcomes examined included 30-day mortality, morbidity, readmission rates, and reoperation.
A total of 703 patients, of which 370 were males (52.6%) underwent splenectomy. A laparoscopic approach was performed on 389 patients (55.3%). all trauma patients underwent open procedures. Indications for splenectomy in decreasing order of frequency ITP (198 patients, 28.2%), splenomegaly/ hypersplenism (113 patients, 16.1%), splenic abscess/infarction (91 patients, 12.9%), leukemia/lymphoma (87 patients, 12.4%), and trauma (77 patients, 11.0%). The 30-day mortality was highest among patients with leukemia and lymphoma (10.3%), trauma (5.2%), and splenic abscess and infarction (4.4%). No mortality was noted in patients with hemolytic anemias or benign splenic lesions. The mortality rate was higher in the open splenectomy group compared to the laparoscopic group (4.8% vs. 1.3%, p=0.006). Overall morbidity was higher in patients who underwent splenectomy for trauma (70%), splenic abscess and infarction (66%), leukemia and lymphoma (40%), or splenomegaly and hypersplenism (40.2%). Overall morbidity was higher in open vs laparoscopic splenectomy (57.6% vs.20.1%, p <0.001). No difference in readmission rate or reoperations between various groups who underwent splenectomy was noted. All patients with traumatic splenic injury underwent an open procedure.
Overall, the 30-day mortality and morbidity after splenectomy were higher in patients with leukemia and lymphoma, trauma, and splenic abscess and infarction. Given the high mortality associated with splenectomy for leukemia and lymphoma, these patients may benefit from prehabilitation and careful procedural timing. Laparoscopic splenectomy was associated with lower morbidity and mortality; therefore, it should be attempted if feasible in all non-emergent conditions.
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