Are the favorable outcomes of splenectomy predictable inpatients with idiopathic thrombocytopenic purpura (ITP)?
BACKGROUND
Historically, splenectomy has been an accepted procedure in the management of immune thrombocytopenic purpura (ITP). However, it is also true that the response to splenectomy in patients with ITP seems to be unpredictable. Therefore, the purpose of this study was to identify clinical variables that might predict a favorable response to splenectomy in patients with ITP.


METHODS
Data were collected retrospectively for 40 adult patients with ITP who underwent laparoscopic (LS) and open (OS) splenectomy at Emory University Hospital between 1992 and 1999. Demographics and outcomes were recorded. Age, sex, disease duration, comorbidities (ASA > 2), previous response to steroids and/or other medications, and preoperative platelet count were analyzed by univariate (t-test, Fisher's exact test) and multivariate statistical methods.


RESULTS
Of the 20 patients in each group, improved platelet counts were noted in 18 patients (90%) in the LS group and 20 patients (100%) in the OS group. Follow-up (16 +/- 3 months) was obtained in 19 LS patients (95%) and 16 OS patients (80%), with 84% and 87.5% sustained response rates, respectively. After univariate analysis, two variables (age and disease duration) were found to be significantly related to the outcome of splenectomy (p <lt; 0.01). However, after multiple logistic regression analysis, only disease duration (relative risk = 1.083; CI, 1.004-1.167) was an independent prognostic factor for a sustained response to splenectomy.


CONCLUSIONS
These results suggest that the response to splenectomy (laparoscopic and open) in patients with ITP cannot be adequately predicted on the basis of presplenectomy clinical variables. However, disease duration and patient age should be taken into consideration when selecting patients for splenectomy.
Tsereteli
Z
Z
Department of Surgery, Emory University Hospital, Room H122, 1364 Clifton Road N.E., Atlanta, GA 30322, USA. ztsereteli@hotmail.com
Smith
C D
CD
Branum
G D
GD
Galloway
J R
JR
Amerson
R J
RJ
Chakaraborty
H
H
Hunter
J G
JG
D000328:Adult; D000367:Age Factors; D002908:Chronic Disease; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D013154:Spleen / Q000601:surgery; D013156:Splenectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome