Management of patients undergoing splenectomy in an Irish teaching hospital: impact of guidelines.
BACKGROUND
Overwhelming post-splenectomy infection (OPSI) has a 50-70% mortality rate and carries a lifetime risk for the asplenic patient. Specific British guidelines have been developed to reduce its incidence.


OBJECTIVE
To determine whether British guidelines were being followed in our own institution and what impact they had on overwhelming post-splenectomy infection.


METHODS
Retrospective chart review of 100 splenectomies performed by Department of Surgery, Beaumont Hospital from January 1990 to January 2000.


RESULTS
Twenty per cent of patients were discharged without any recommended vaccinations. Prophylactic antibiotics were not prescribed in 53% of patients. Just 12% of charts document a verbal explanation of the complications and management of asplenia to the patient. Overall septic mortality was 12%, of whom 8% died in hospital and 4% after discharge.


CONCLUSIONS
Management of the asplenic patient has improved but is far from complete. A central register of asplenic patients and national asplenic guidelines should be established in Ireland to ensure optimum patient care.
O'Donnell
J
J
Royal College of Surgeons in Ireland, Department of Surgery, Beaumont Hospital, Dublin. jillodon@hotmail.com
McGreal
G
G
Daly
P
P
Crowley
R
R
Barry
M C
MC
Broe
P
P
Bouchier-Hayes
D J
DJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007494:Ireland; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011182:Postoperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D015996:Survival Rate