title: Adherence to vaccination guidelines post splenectomy: A five year follow up study.
abstract: Following a splenectomy patients are at increased risk of significant infections. In its most severe form, overwhelming post-splenectomy infection (OPSI) has a mortality rate of up to 80%. In this study we aim to establish the adherence to vaccination and antibiotic national guidelines in splenectomised patients. A retrospective study of 100 patients who underwent splenectomy (21 emergency, 79 elective), in two teaching hospitals was undertaken over a five-year period. Patients were followed up for five years. Hospital and GP records were reviewed for adherence to pre, intra and postoperative vaccination, thromboprophylaxis and antibiotic guidance. Eighty-six eligible patients (91.5%) received their Haemophilus influenzae B, meningococcal C and pneumococcus vaccinations peri-operatively. Eighty-one (86%) received post-operative antibiotics. Ninety-nine percent of patients received thromboprophylaxis treatment. Eighty-nine (95%) were treated with long-term antibiotic prophylaxis. Only 20 patients (23%) had an emergency supply of antibiotics. Ninety-five percent of patients were administered an annual influenza vaccination and 84% of eligible patients received a five-year pneumococcal booster vaccination. Improvement in the management of this patient cohort can be achieved by a multidisciplinary approach involving adherence to national guidelines, standardised trust protocols, patient information leaflets and advice detailing risk of infection, standardised GP letters and a splenectomy register to monitor and manage this vulnerable group of patients.
authors.affiliation: Nottingham University Hospitals, Nottingham, UK. Electronic address: Tristanboam@doctors.org.uk.
authors.forename: Tristan
authors.initials: T
authors.lastname: Boam
authors.affiliation: Nottingham University Hospitals, Nottingham, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Sellars
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1).
authors.forename: John
authors.initials: J
authors.lastname: Isherwood
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1).
authors.forename: Chloe
authors.initials: C
authors.lastname: Hollobone
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1).
authors.forename: Cristina
authors.initials: C
authors.lastname: Pollard
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1).
authors.forename: David M
authors.initials: DM
authors.lastname: Lloyd
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1).
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, University of Leicester, Leicester, UK(1).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013156:Splenectomy; D014611:Vaccination; D055815:Young Adult
keywords: Guidelines; Splenectomy; Vaccinations