Indications for and efficacy of splenectomy for haematological disorders

• Published in: British journal of surgery Vol. 100; no. 6; pp. 794 - 800
• Main Authors: Bickenbach, K. A., Gonen, M., Labow, D. M., Strong, V., Heaney, M. L., Zelenetz, A. D., Coit, D. G.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.05.2013; Oxford University Press
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Blood Loss, Surgical - statistics & numerical data; Child; Child, Preschool; Conversion to Open Surgery - statistics & numerical data; Female; Hematologic Diseases - surgery; Hemoglobins - metabolism; Humans; Infant; Laparotomy - methods; Laparotomy - mortality; Male; Middle Aged; Operative Time; Platelet Count; Postoperative Complications - etiology; Risk Factors; Splenectomy - methods; Splenectomy - mortality; Treatment Outcome; Young Adult
• ISSN: 0007-1323; 1365-2168; 1365-2168
• DOI: 10.1002/bjs.9067

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. Not without risks