title: Factors associated with the effect of open splenectomy for immune thrombocytopenic purpura.
abstract: OBJECTIVE
  To assess the effect and complications of open splenectomy (OS) for immune thrombocytopenic purpura (ITP) and determine preoperative factors associated with surgical effect.
  
  
  METHODS
  This was a retrospective analysis of ITP patients who failed medical therapy and were treated with OS between 1997 and 2014 at the Jinshan Hospital, China. Follow-up was 60 months. Surgical effect was determined from platelet counts and bleeding episodes. Complications were assessed including bleeding episodes. Preoperative factors were identified by logistic regression analysis.
  
  
  RESULTS
  Fifty-six patients (48.2 ± 16.2 yr old; 39 females) were included. Disease course was 31.2 ± 48.2 months; 91.1% patients had preoperative platelet count <20 × 109/L. OS effect at 1 wk, 1 month, 1 yr, and 5 yrs was in 91.1%, 92.9%, 91.1%, and 89.3% patients, respectively. Pneumonia or lower extremity thrombosis occurred in 7.1% patients. Postoperative mild, moderate, and severe bleeding occurred in 33.9%, 50.0%, and 16.1% patients, respectively. No patients required blood transfusion. Mortality was zero. Larger spleen size associated with surgical effect at 1 wk, 1 month, and 1 yr, and lower preoperative minimum platelet count associated with effect at 5 yrs (P < 0.05).
  
  
  CONCLUSIONS
  Open splenectomy is an effective treatment with less complications for the management of ITP. Lower preoperative minimum platelet count associated with successful OS at 5 yrs.
authors.affiliation: Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China.
authors.forename: Dawei
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China.
authors.forename: Fanli
authors.initials: F
authors.lastname: Hua
authors.affiliation: Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China.
authors.forename: Song
authors.initials: S
authors.lastname: Gao
authors.affiliation: Department of Hematology, Jinshan Hospital Fudan University, Shanghai, China.
authors.forename: Yangjiong
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Hematology, Zhongshan Hospital Fudan University, Shanghai, China.
authors.forename: Jianmin
authors.initials: J
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: efficacy; immune thrombocytopenic purpura; platelet count; safety; splenectomy