title: Morbidity- and mortality-related prognostic factors of nontraumatic splenectomies.
abstract: BACKGROUND
  Splenectomy is a common surgical procedure, but few reports focus on nontraumatic splenectomies. The aim of this study was to determine the predictors of morbidity and mortality of patients submitted to elective nontraumatic splenectomy.
  
  
  METHODS
  A descriptive cross-sectional study of 152 consecutive, nonselected, nontraumatic patients operated on by splenectomy between 1996 and 2010 was carried out. Clinical, laboratory, and surgical data, histological findings, perioperative mortality, and postoperative complications according to Clavien-Dindo classification, were recorded. Factors related to morbidity and mortality were analyzed.
  
  
  RESULTS
  Of the 152 patients (89 male and 63 female; mean age 49.8 ± 17.8 years), 74 (48.7%) were operated on for malignant hematologic disorders, 44 for benign hematologic process, and 34 for other nonhematologic disorders. The spleen was enlarged in 95 patients (62.5%) and 78 patients (51.3%) had hypersplenism. The overall complications rate was 40.1%: Grades I and II in 27 cases (17.7%), and Grades III and IV in 23 patients (15.1%). Perioperative mortality was 7.2% (11 patients). In univariate analysis, significant negative predictors for morbidity were age (p = 0.004), anemia (p = 0.03), leukocytosis (p = 0.016), and blood transfusions (p < 0.001). In the multivariate analysis, only the need for blood transfusion remained as an independent prognostic factor (p = 0.001). Related to mortality, negative prognostic factors were age (p = 0.003), leukocytosis (p = 0.048), American Society of Anesthesiologists (ASA) score (p < 0.001), blood transfusion (p < 0.001), pleural effusion (p = 0.031), and pneumonia (p = 0.001). Pneumonia remained an independent prognostic factor of mortality (p = 0.024).
  
  
  CONCLUSIONS
  Blood loss is the most important prognostic factor for postoperative complications after nontraumatic splenectomies. Pneumonia is the main prognosis factor for perioperative mortality.
authors.affiliation: Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain. Electronic address: rjgianchandani@hotmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gianchandani Moorjani
authors.affiliation: Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Marchena-Gomez
authors.affiliation: Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Casimiro-Perez
authors.affiliation: Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Roque-Castellano
authors.affiliation: Department of General Surgery, Hospital Universitario Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Ramirez-Felipe
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D013156:Splenectomy / Q000009:adverse effects* / Q000401:mortality*
keywords: morbidity; mortality; nontrauma; prognosis factors; splenectomy