Splenectomy is associated with higher infection and pneumonia rates among trauma laparotomy patients

• Published in: The American journal of surgery Vol. 213; no. 5; pp. 856 - 861
• Main Authors: Fair, Kelly A, Connelly, Christopher R, Hart, Kyle D, Schreiber, Martin A, Watters, Jennifer M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017; Elsevier Limited
• Subjects: Abdomen; Coma; Databases, Factual; Female; Health risk assessment; Health risks; Heart rate; Hospitalization; Hospitals; Humans; Infection; Infection - epidemiology; Infection - etiology; Infections; Injuries; Injury Severity Score; Laparotomy; Logistic Models; Male; Patients; Pneumonia; Pneumonia - epidemiology; Pneumonia - etiology; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Propensity Score; Regression analysis; Respiratory distress syndrome; Retrospective Studies; Risk Factors; Sepsis; Spleen; Splenectomy; Splenectomy - adverse effects; Statistical analysis; Surgery; Thromboembolism; Trauma; Ulcers; Variables; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology; Ventilators; Wounds and Injuries - surgery; infection; pneumonia; Trauma; splenectomy; Splenectomy; Infection; Pneumonia
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.04.001

Abstract Splenectomy increases lifetime risk of thromboembolism (VTE) and is associated with long-term infectious complications, primarily, overwhelming post-splenectomy infection (OPSI). Our objective was to evaluate risk of VTE and infection at index hospitalization post-splenectomy. Retrospective review of all patients who received a laparotomy in the NTDB. Propensity score matching for splenectomy was performed, based on ISS, abdominal abbreviated injury score >3, GCS, sex and mechanism. Major complications, VTE, and infection rates were compared. Multiple logistic regression models were utilized to evaluate splenectomy-associated complications. 93,221 laparotomies were performed and 17% underwent splenectomy. Multiple logistic regression models did not demonstrate an association between splenectomy and major complications (OR 0.96, 95% CI 0.91-1.03, p =0.25) or VTE (OR 1.05, 95% CI 0.96-1.14, p =0.33). Splenectomy was independently associated with infection (OR 1.07, 95% CI 1.00-1.14, p =0.045). Subgroup analysis of patients with infection demonstrated that splenectomy was most strongly associated with pneumonia (OR 1.41, 95% CI 1.26-1.57, p <0.001). Splenectomy is not associated with higher overall complication or VTE rates during index hospitalization. However, splenectomy is associated with a higher rate of pneumonia.