Risk factors associated with mortality and morbidity after elective splenectomy.
OBJECTIVE
To assess the effect of certain risk factors on the outcome of elective splenectomy.


METHODS
Retrospective cohort study.


METHODS
University hospital, Norway.


METHODS
135 patients who underwent elective splenectomy from 1978 to 1992 for autoimmune diseases (n = 58), myeloproliferative disorders (n = 58), and other diagnoses (n = 19).


METHODS
Morbidity and mortality, and the effect on outcome of age, malignancy, platelet count, treatment with steroids, and blood transfusion during the operative period.


RESULTS
Three patients died, one from each diagnostic group; all had been treated with steroids. The overall complication rate was 31% (42/135). Most of the complications (31, 74%) were infective (pneumonia n = 23, abscess or sepsis n = 8). Nine patients required reoperation (haemorrhage, n = 6, and wound dehiscence, n = 2, and bowel obstruction, n = 1). Neither treatment with steroids nor severe thrombocytopaenia were risk factors for any complication, but age (p = 0.05) and a diagnosis of myeloproliferative disease (p = 0.08) had an important though not significant role. Blood transfusion during the operative period was the only independent risk factor (p = 0.001), and further analysis showed that transfusion of blood had a dose dependent effect on the incidence of infective complications (chi-square for linear trend 14.21 p < 0.001).


CONCLUSIONS
To reduce the complication rate of elective splenectomy blood transfusion during the operative period should be avoided.
Aksnes
J
J
Surgical Department, National Hospital, University of Oslo, Norway.
Abdelnoor
M
M
Mathisen
O
O
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000601:surgery; D001424:Bacterial Infections / Q000453:epidemiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000453:epidemiology / Q000601:surgery; D009664:Norway / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects* / Q000401:mortality*; D013256:Steroids / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000453:epidemiology; D065227:Transfusion Reaction; D016896:Treatment Outcome
D013256:Steroids