title: Safety and efficacy of splenectomy in over 65-yrs-old patients with immune thrombocytopenia.
abstract: OBJECTIVE
  Few studies specifically focus on elderly splenectomized immune thrombocytopenia (ITP) patients. Older patients with ITP and excellent health are often excluded from surgery splenectomy. We aimed to compare the safety and efficacy of splenectomy in elderly and non-elderly ITP patients and to examine the effect of age on therapeutic response.
  
  
  METHODS
  We carried out a retrospective analysis of a series of 218 patients who had undergone splenectomy for ITP. We compared the data from the elderly group (≥65 yrs, 57 patients) with the young group (<65 yrs, 162 patients).
  
  
  RESULTS
  Surgical technique (laparoscopy or open laparotomy splenectomy) was comparable between the two age groups. The adjusted risk of major bleeding following splenectomy for elderly patients was three times that for young patients (OR 3.05, 95% CI: 1.44-6.52). The median duration of postoperative hospital stay was longer for elderly than for young patients (8 d vs. 4 d, P < 0.001). However, we identified a subgroup of elderly ITP patients, those aged between 65 and 70 yrs who had undergone laparoscopic splenectomy, with a low risk of postoperative complications. Of the 218 patients, 89% achieved a favorable response to splenectomy. A favorable response was significantly less common in elderly than in young people (79% vs. 92%, P = 0.005). However, we observed an acceptable long-term control of ITP in the elderly group, in which the probability of maintaining response for 14 yrs after splenectomy was 56%.
  
  
  CONCLUSIONS
  Patients aged ≥65 yrs experienced negative effects on safety and efficacy outcomes of splenectomy for ITP, but further studies are needed to identify predictors of postsplenectomy outcomes in this group.
authors.affiliation: Department of Hematology, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Gonzalez-Porras
authors.affiliation: Department of Hematology, Complejo Hospitalario Universitario de Leon, Leon, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Escalante
authors.affiliation: Department of Hematology, Hospital Virgen del Puerto, Plasencia, Spain.
authors.forename: Emilia
authors.initials: E
authors.lastname: Pardal
authors.affiliation: Department of Hematology, Hospital Virgen de la Concha, Zamora, Spain.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Sierra
authors.affiliation: Department of Hematology, Hospital Universitario Rio Hortega, Valladolid, Spain.
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Garcia-Frade
authors.affiliation: Department of Hematology, Complejo Asistencial de Avila, Avila, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Redondo
authors.affiliation: Department of Hematology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Maryam
authors.initials: M
authors.lastname: Arefi
authors.affiliation: Department of Hematology, Complejo Asistencial de Soria, Soria, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Aguilar
authors.affiliation: Department of Hematology, Complejo Asistencial de Palencia, Palencia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ortega
authors.affiliation: Department of Hematology, Hospital del Bierzo, Ponferrada, Spain.
authors.forename: Erik
authors.initials: E
authors.lastname: de Cabo
authors.affiliation: Department of Hematology, Complejo Asistencial de Segovia, Segovia, Spain.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Fisac
authors.affiliation: Department of Surgery, Complejo Hospitalario Universitario de Leon, Leon, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Sanz
authors.affiliation: Department of Surgery, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Esteban
authors.affiliation: Department of Hematology, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Alberca
authors.affiliation: Department of Statistics, Universidad de Salamanca, Salamanca, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Sanchez-Barba
authors.affiliation: Department of Coding, Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Santos
authors.affiliation: Department of Coding, Complejo Asistencial de Burgos, Burgos, Spain.
authors.forename: Abel
authors.initials: A
authors.lastname: Fernandez
authors.affiliation: Department of Hematology, Complejo Asistencial de Burgos, Burgos, Spain.
authors.forename: Tomas J
authors.initials: TJ
authors.lastname: Gonzalez-Lopez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013156:Splenectomy / Q000009:adverse effects; D016896:Treatment Outcome
keywords: efficacy; immune thrombocytopenia; mortality; safety; splenectomy