title: Trends in splenectomy: where does laparoscopy stand?
abstract: OBJECTIVE
  Laparoscopic splenectomy (LS) has been shown to offer superior outcomes when compared to open splenectomy (OS). Despite the potential advantages associated with the minimally invasive technique, laparoscopy appears to be underused. We sought to evaluate the nationwide trends in LS.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) database was queried for both OS and LS procedures performed from 2005 through 2010. Partial splenectomies and those performed for traumatic injury, vascular anomaly, or as part of a pancreatectomy were excluded. The included cases were examined for age of the patient and comorbid conditions. We then evaluated the postoperative complications, overall morbidity, mortality, and length of hospital stay.
  
  
  RESULTS
  A total of 37,006 splenectomies were identified. Of those, OS accounted for 30,108 (81.4%) cases, LS for 4,938 (13.3%), and conversion to open surgery (CS) for 1,960 (5.3%). The overall rate of morbidity was significantly less in the LS group than in the OS group (7.4% vs 10.4%; P < .0001). The LS group had less mortality (1.3% vs 2.5%, P < .05) and a shorter length of stay (5.6 ± 8 days vs 7.5 ± 9 days).
  
  
  CONCLUSIONS
  Despite the benefits conferred by LS, it appears to be underused in the United States. There has been an improvement in the rate of splenectomies completed laparoscopically when compared to NIS data from the past (8.8% vs 13%; P < .05). The conversion rate is appreciably higher for LS than for other laparoscopic procedures, suggesting that splenectomies require advanced laparoscopic skills and that consideration should be given to referring patients in need of the procedure to appropriately experienced surgeons.
authors.affiliation: Department of Surgery, Barnabas Health Medical Group, Howell, New Jersey, USA.
authors.forename: Gurdeep S
authors.initials: GS
authors.lastname: Matharoo
authors.affiliation: Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Staten Island University Hospital, New York, USA.
authors.forename: John N
authors.initials: JN
authors.lastname: Afthinos
authors.affiliation: Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Staten Island University Hospital, New York, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Gibbs
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D013156:Splenectomy / Q000379:methods* / Q000639:trends*; D013158:Splenic Diseases / Q000601:surgery*; D014481:United States / Q000453:epidemiology
keywords: Conversion to open; Laparoscopy; NIS database; Splenectomy