Risks of synchronous gastrointestinal or biliary surgery with splenectomy for hematologic disease.
BACKGROUND
The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mortality, morbidity, and even survival.


OBJECTIVE
To determine the risks of the converse: synchronous GI surgery appended to splenectomy for hematologic diseases.


METHODS
Retrospective cohort.


METHODS
Multiple hospitals comprising an affiliated surgical training program.


METHODS
Consecutive sample of 207 adults (mean age, 49 years) with splenectomies for hematologic diseases.


METHODS
Splenectomy and concomitant GI or biliary surgery (group 1, n=19) and splenectomy alone (group 2, n=188).


METHODS
Length of hospital or intensive care unit stay, later operations, postoperative infections, postoperative abdominal abscess, major complications, and death.


RESULTS
Preoperative and intraoperative factors were similar in both groups. Operative mortality was 3 of 19 in group 1 and 8 of 188 in group 2 (p=.07). The mean number of major complications tended to be higher in group 1 (1.5 vs 0.5, P=07). Despite no difference between the incidences of overall postoperative infections, patients in group 1 were much more likely to develop an abdominal abscess (4 of 19 vs 3 of 188, P=.002). Logistic regression established that patients undergoing splenectomy and synchronous GI or biliary surgery were 25 times more likely to develop an intra-abdominal abscess than were patients with splenectomy alone, even controlling for confounding factors (odds ratio, 24.7; 95% confidence interval, 3.1 to 196; P=.002).


CONCLUSIONS
Synchronous GI or biliary surgery with splenectomy for hematologic disease increases the risk of intra-abdominal abscess and should be avoided. Complication and mortality rates may also be increased.
McAneny
D
D
Section of Surgical Oncology, Boston University Medical Center, Boston, Mass., USA.
Godek
C P
CP
Scott
T E
TE
LaMorte
W W
WW
Beazley
R M
RM
D018784:Abdominal Abscess / Q000209:etiology; D000328:Adult; D000704:Analysis of Variance; D001662:Biliary Tract Surgical Procedures; D013505:Digestive System Surgical Procedures; D005260:Female; D006402:Hematologic Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy