title: The impact of operative approach in elective splenectomy: a multivariate analysis of outcomes from the NSQIP database.
abstract: OBJECTIVE
  Laparoscopy is an increasingly prevalent choice for elective splenectomy but it carries an inconsistent documentation of complications. This study examines 30-day postoperative outcomes after open (OS) and laparoscopic (LS) splenectomy.
  
  
  METHODS
  Elective splenectomies were extracted from the National Surgical Quality Improvement Program database. Multivariate analysis determined factors associated with complications and an increased postoperative length of stay (LOS).
  
  
  RESULTS
  There were a total of 1583 splenectomies with 991 (63.0%) laparoscopic cases. On univariate analysis, the LS group had fewer major (10.6% vs. 18.8%, P<0.0001) and minor complications (2.6% vs. 7.1%, P<0.0001). Adjusting for baseline differences, LS was not associated with an increase in major complications [odds ratio (OR), 0.76; 95% confidence interval, 0.54-1.08; P = 0.1255] but offered a decrease in minor complications (OR, 0.41; 95% confidence interval, 0.24-0.69; P = 0.0010) coupled with a decrease in postoperative LOS of 1.89 ± 0.30 days (P<0.0001) compared with OS.
  
  
  CONCLUSIONS
  After accounting for comorbidities and intraoperative factors, laparoscopy remains a safe choice for elective splenectomy with fewer complications and shorter LOS.
authors.affiliation: Department of Surgery and Biostatistics, University of Rochester Medical Center, Rochester, NY 14642, USA.
authors.forename: Andrew-Paul
authors.initials: AP
authors.lastname: Deeb
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kim
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: Susan
authors.initials: S
authors.lastname: Messing
authors.forename: Douglas
authors.initials: D
authors.lastname: Gunzler
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
authors.forename: Rabih M
authors.initials: RM
authors.lastname: Salloum
mesh_terms: D016208:Databases, Factual / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D058996:Quality Improvement; D013156:Splenectomy / Q000379:methods*