title: Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database.
abstract: BACKGROUND
  Nearly half of all incidental splenectomies caused by iatrogenic splenic injury occur during colorectal surgery. This study evaluates factors associated with incidental splenic procedures during colorectal surgery and their impact on short-term outcomes using a nationwide database.
  
  
  METHODS
  Patients who underwent colorectal resections between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database according to Current Procedural Terminology codes. Patients were classified into two groups based on whether they underwent a concurrent incidental splenic procedure at the time of the colorectal procedure. All splenic procedures except a preoperatively intended splenectomy performed in conjunction with colon or rectal resections were considered as incidental. Perioperative and short-term (30 day) outcomes were compared between the groups.
  
  
  RESULTS
  In total, 93633 patients who underwent colon and/or rectal resection were identified. Among these, 215 patients had incidental splenic procedures (153 open splenectomy, 17 laparoscopic splenectomy, 36 splenorraphy, and 9 partial splenectomy). Open colorectal resections were associated with a significantly increased likelihood of incidental splenic procedures (OR 6.58, p < 0.001) compared to laparoscopic surgery. Incidental splenic procedures were associated with increased length of total hospital stay (OR 1.25, p < 0.001), mechanical ventilation dependency (OR 1.62, p = 0.02), transfusion requirement (OR: 3.84, p < 0.001), re-operation requirement (OR 1.7, p = 0.005), and sepsis (OR: 2.03, p = 0.001). Short-term advantages of splenic salvage (splenorraphy or partial splenectomy) included shorter length of total hospital stay (p = 0.001) and decreased need for re-operation (p < 0.001).
  
  
  CONCLUSIONS
  Incidental splenic procedures during colorectal resections are associated with worse short-term outcomes. Use of the laparoscopic technique decreases the need for incidental splenic procedures.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Ozgen
authors.initials: O
authors.lastname: Isik
authors.forename: Erman
authors.initials: E
authors.lastname: Aytac
authors.forename: Jean
authors.initials: J
authors.lastname: Ashburn
authors.forename: Gokhan
authors.initials: G
authors.lastname: Ozuner
authors.forename: Feza
authors.initials: F
authors.lastname: Remzi
authors.forename: Meagan
authors.initials: M
authors.lastname: Costedio
authors.forename: Emre
authors.initials: E
authors.lastname: Gorgun
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012042:Registries; D013154:Spleen / Q000293:injuries*; D013158:Splenic Diseases / Q000453:epidemiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology