title: Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy.
abstract: OBJECTIVE
  To evaluate 30-day postoperative outcomes in laparoscopic (LS) versus open splenectomy (OS).
  
  
  BACKGROUND
  LS has generally been associated with lower rates of postoperative complications than OS. However, evidence mainly comes from small studies that failed to adjust for the confounding effects of the underlying indication or clinical condition that may have favored the use of one technique over the other.
  
  
  METHODS
  A retrospective cohort study of patients undergoing splenectomy in 2008 and 2009 using data from the American College of Surgeons National Surgical Quality Improvement Program database (n = 1781). Retrieved data included 30-day mortality and morbidity (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thromboembolism, and major bleeding outcomes), demographics, indication, and preoperative risk factors. We used multivariate logistic regression to assess the adjusted effect of the splenectomy technique on outcomes.
  
  
  RESULTS
  A total of 874 (49.1%) cases had LS and 907 (50.9%) had OS. After adjusting for all potential confounders including the indication and preoperative risk factors, LS was associated with decreased 30-day mortality [OR (odds ratio): 0.39, 95% CI: 0.18-0.84] and postoperative respiratory occurrences (OR: 0.46, 95% CI: 0.27-0.76), wound occurrences (OR: 0.37, 95% CI: 0.11-0.79), and sepsis (OR: 0.52, 95% CI: 0.26-0.89) when compared with OS. Patients who underwent LS also had a significantly shorter total length of hospital stay and were less likely to receive intraoperative transfusions compared with patients who underwent OS.
  
  
  CONCLUSIONS
  LS is associated with more favorable postoperative outcomes than OS, irrespective of the indication for splenectomy or the patient's clinical status.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Musallam
authors.forename: Mohamed
authors.initials: M
authors.lastname: Khalife
authors.forename: Pierre M
authors.initials: PM
authors.lastname: Sfeir
authors.forename: Walid
authors.initials: W
authors.lastname: Faraj
authors.forename: Bassem
authors.initials: B
authors.lastname: Safadi
authors.forename: George S
authors.initials: GS
authors.lastname: Abi Saad
authors.forename: Firass
authors.initials: F
authors.lastname: Abiad
authors.forename: Ali
authors.initials: A
authors.lastname: Hallal
authors.forename: Melhim Bou
authors.initials: MB
authors.lastname: Alwan
authors.forename: Flora
authors.initials: F
authors.lastname: Peyvandi
authors.forename: Faek R
authors.initials: FR
authors.lastname: Jamali
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D013156:Splenectomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome