title: Splenectomy sequelae: an analysis of infectious outcomes among adults in Victoria.
abstract: OBJECTIVE
  To determine the risk and timing of a broad range of infective outcomes and mortality after splenectomy.
  
  
  METHODS
  Analysis of a non-identifiable linked hospital discharge administrative dataset for splenectomy cases between July 1998 and December 2006 in Victoria, Australia.
  
  
  METHODS
  Age, sex, indication for splenectomy, infectious events and death. Patients splenectomised for trauma were compared with patients splenectomised for other indications. Infectious risk was established using Cox proportional hazards models.
  
  
  RESULTS
  A total of 2574 patients underwent splenectomy (with 8648 person-years follow-up). Paediatric cases were excluded, leaving 2472 adult cases for analysis. The most common reasons for splenectomy were trauma (635 [25.7%]) and therapeutic haematological indications (583 [23.6%]). After splenectomy, 644 adult patients (26.0%) had a severe infection, with a rate of 8.0 per 100 person-years (95% CI, 7.2-8.4). The risk of severe infection was highest among patients aged > [corrected] 50 years (10.1 [corrected] per 100 person-years; 95% CI, 9.3-11.1) [corrected] and those splenectomised for malignancy (14.2 per 100 person-years; 95% CI, 11.8-17.1). Gram-negative infections represented the most frequent causative organism group accounting for 698 (51%) of bacterial pathogens. Staphylococcus aureus was the second most common causative organism.
  
  
  CONCLUSIONS
  The incidence of severe infection and all-cause mortality differed according to age and underlying reason for splenectomy, and was highest among the elderly and those with malignancy, and was lowest among trauma patients. This highlights the need for targeted prevention programs.
authors.affiliation: Department of Infectious Diseases, Monash Medical Centre, Southern Health, Melbourne, VIC. claire.dendle@monash.edu
authors.forename: Claire
authors.initials: C
authors.lastname: Dendle
authors.forename: Vijaya
authors.initials: V
authors.lastname: Sundararajan
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.forename: Damien
authors.initials: D
authors.lastname: Jolley
authors.forename: Ian
authors.initials: I
authors.lastname: Woolley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D013156:Splenectomy / Q000401:mortality; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology; D013997:Time Factors; D014739:Victoria