title: Safety of laparoscopic splenectomy in elderly patients with idiopathic thrombocytopenic purpura.
abstract: Laparoscopic splenectomy (LS) for immune thrombocytopenic purpura (ITP) is very successful. However, the safety of LS in older patients who have less cardiac and pulmonary reserve has not been studied. Our objective was to compare results of LS in elderly and younger patients with ITP. LS performed for ITP between 1992 and 1999 were studied. Perioperative data were collected concurrently. Follow-up was obtained by chart review and phone interview. Groups were arbitrarily divided: Group A, age > or =70; group B, age <70. Main outcome measures were platelet response, duration of operation, hospitalization, blood loss, and complications were compared using t test and Chi-square analyses. Group A had more comorbid conditions (80% vs 28%, P = 0.04). Operative time (80 vs 119 minutes, P = 0.23), estimated blood loss (156 vs 189 cm3, P = 0.62), and hospitalization (3.6 vs 2.8 days, P = 0.23) were similar for both groups. Although group B had significantly more patients with an early platelet response (70% vs 97%, P = 0.02), there was no difference in platelet response at long-term follow-up (70% vs 84%, P = 0.22). Long-term follow-up was completed on 87 per cent of patients at an average of 43 months postoperatively. We conclude that LS is safe and effective in elderly patients with ITP.
authors.affiliation: Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Fass
authors.forename: T T
authors.initials: TT
authors.lastname: Hui
authors.forename: A
authors.initials: A
authors.lastname: Lefor
authors.forename: U
authors.initials: U
authors.lastname: Maestroni
authors.forename: E H
authors.initials: EH
authors.lastname: Phillips
mesh_terms: D000367:Age Factors; D000368:Aged; D016063:Blood Loss, Surgical; D001792:Blood Platelets / Q000502:physiology; D016009:Chi-Square Distribution; D004194:Disease; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012449:Safety; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome