title: Acute chest syndrome after splenectomy in children with sickle cell disease.
abstract: OBJECTIVE
  The purpose of this study was to determine the incidence of acute chest syndrome (ACS) in children with sickle cell disease (SCD) undergoing laparoscopic or open splenectomy and to assess factors that may predispose to this complication.
  
  
  METHODS
  A retrospective review of all patients with SCD undergoing splenectomy between 1999 and 2007 in our institution. Charts were screened for demographics, perioperative clinical status (vaso-occlusive crises, sequestration crises), preoperative hemoglobin electrophoresis and preoperative transfusion, postoperative development of ACS, and need for an intensive care unit (ICU) admission.
  
  
  RESULTS
  Forty-three children with SCD, 17 females and 16 males (mean age 9 years), underwent splenectomy (19 laparoscopy and 24 open). Acute chest syndrome occurred in 9 patients (20%), 1 (5.2%) of 19 in the laparoscopy group, and 8 (33.3%) of the 24 in the open group. All patients with ACS were admitted to the ICU. Acute chest syndrome developed within the first 24 hours in 5 of the 9 patients, on the second postoperative day in 1 patient, and more than 1 month postoperatively in 3 patients. Six of 9 patients with ACS had been transfused preoperatively. All patients with ACS had had vaso-occlusive crises before surgery. Five of 9 patients who developed ACS had previous ACS episodes before surgery. There was no death in our series.
  
  
  CONCLUSIONS
  The incidence of ACS is in accordance with the literature. Preoperative transfusions did not prevent ACS. There is a clear tendency for laparoscopically operated patients to experience less ACS postoperatively. In our group of patients, there were no clear benefits for routine perioperative admission to the ICU.
authors.affiliation: Saudi Aramco Medical Services Organization, Dhahran 31311, Saudi Arabia.
authors.forename: Salim
authors.initials: S
authors.lastname: Ghantous
authors.forename: Saad
authors.initials: S
authors.lastname: Al Mulhim
authors.forename: Nafeesa
authors.initials: N
authors.lastname: Al Faris
authors.forename: Basel
authors.initials: B
authors.lastname: Abushullaih
authors.forename: Firas
authors.initials: F
authors.lastname: Shalak
authors.forename: Salam
authors.initials: S
authors.lastname: Yazbeck
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000453:epidemiology* / Q000601:surgery*; D015984:Causality; D002637:Chest Pain / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D013577:Syndrome