Adherence to guidelines for prevention of postsplenectomy sepsis. Age and sex are risk factors: a five-year retrospective review.
BACKGROUND
Vaccination, education and use of long-term antibiotics are recommended in expert guidelines for the prevention of infectious complications after splenectomy. However, studies outside Australia have shown poor adherence to the guidelines.


METHODS
The aim of this study was to determine overall adherence to the guidelines and to ascertain any independent risk factors for poor compliance with the guidelines. A retrospective review of hospital records between 1999 and 2004 was carried out.


RESULTS
Indications for splenectomy of the 111 patients in this review included post-trauma (32), haematological (32), cancer surgery (24), iatrogenic (12) and others (11). On multivariable analysis, age was associated with a 28% less likelihood to receive education (odds ratio (OR) 0.72; 95% confidence interval (CI) 0.56-0.92; P = 0.009) and 36% less likelihood to receive long-term antibiotics (OR 0.64; 95% CI 0.52-0.80; P < or = 0.001). Women were four times more likely to receive education (OR 4.03; 95% CI 1.16-14.0; P = 0.028) and patients who had undergone splenectomy in 2004 were 22 times more likely to have received education compared with those in 1999 (OR 22.53; 95% CI 3.12-162.34; P = 0.002).


CONCLUSIONS
Education for prevention of sepsis after splenectomy is poorly documented and may be incomplete. Older age and male sex are risk factors in non-adherence to guidelines for prevention of postsplenectomy sepsis. Strategies such as alert cards and information brochures may improve adherence to guidelines particularly in older patients.
Kotsanas
Despina
D
Department of Infectious Diseases, Monash Medical Centre, Melbourne, Victoria, Australia. despina.kotsanas@southernhealth.org.au
Al-Souffi
Mohammed H
MH
Waxman
Bruce P
BP
King
Richard W F
RW
Polkinghorne
Kevan R
KR
Woolley
Ian J
IJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012737:Sex Factors; D013156:Splenectomy / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D015996:Survival Rate; D013997:Time Factors; D014611:Vaccination / Q000379:methods*; D014739:Victoria / Q000453:epidemiology
D000900:Anti-Bacterial Agents