An audit of splenectomies in a teaching hospital in North India. Are postsplenectomy guidelines being complied with?
OBJECTIVE
Patients with an absent or dysfunctional spleen are at risk of infection by encapsulated and other bacteria. Overwhelming postsplenectomy infection (OPSI) causes most concern because it can result in significant mortality. A retrospective review of splenectomised patients in a tertiary care setting over an eight year period was carried out to determine whether current postsplenectomy guidelines were being followed.


METHODS
The cases were identified from the medical records and pathology files and data such as the reason for splenectomy, the preventive measures taken regarding vaccination, and antibiotic prophylaxis, together with their documentation in the discharge notes were assessed.


RESULTS
Fifty six patients were studied. Trauma, both blunt and penetrating, was the most common reason for splenectomy. Thirty six patients received pneumococcal vaccination, with 20 patients having no mention of vaccination in their case notes. The discharge notes of 50 patients mentioned their splenectomised status; however, documentation of vaccination details in the discharge summary was poor, with only three patients having the relevant information recorded. Documentation of the need for future vaccination and precautions required in the asplenic condition was also lacking. Nine patients had postsplenectomy complications, although there were no cases of OPSI.


CONCLUSIONS
Adherence to standard guidelines for the management of splenectomised patients was unsatisfactory. There is a need for an improvement of the vaccination rate and careful documentation of this important health risk in the discharge summaries. Maintenance of a splenectomy registry could aid in optimising the management of these patients.
Deodhar
M
M
Department of Surgery, Christian Medical College and Hospital, Ludhiana-141 008, Punjab, India.
Kakkar
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D007194:India; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000517:prevention & control; D011182:Postoperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013156:Splenectomy; D014611:Vaccination
D000900:Anti-Bacterial Agents