Splenectomy in high-risk patients with splenomegaly.
BACKGROUND
Splenectomy in patients with massive splenomegaly and hematologic malignancy results in higher morbidity and mortality with primarily palliative benefit.


METHODS
From a 14-year experience with 172 splenectomies, the perioperative course of 39 high-risk patients with splenomegaly was reviewed for comorbidities, indications, complications, and mortality.


RESULTS
Twenty-three males and 16 females with a mean age of 54.2 years and a mean 12.8-day postoperative length of stay were reviewed. Sixteen patients (41%) had 23 major complications related to age (P = 0.047) and operative time (P = 0.01). Intraoperative transfusion was related to splenic size (P = 0.04), and estimated blood loss (P = 0.02) was inversely related to use of splenic artery preligation. Three perioperative deaths were secondary to sepsis and multi-organ system failure.


CONCLUSIONS
Splenomegaly and comorbidities of the primary disease result in higher morbidity and mortality. Splenic artery preligation is valuable to limit intraoperative blood loss and facilitate splenectomy.
Nelson
E W
EW
Department of Surgery, University of Utah School of Medicine, Salt Lake City 84132, USA.
Mone
M C
MC
D015897:Comorbidity; D005260:Female; D019337:Hematologic Neoplasms / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D013156:Splenectomy / Q000401:mortality; D013163:Splenomegaly / Q000601:surgery*