Management of post-splenectomy patients in the Netherlands

Abstract

After splenectomy, patients are at increased risk of sepsis with considerable mortality. The risk of sepsis can be reduced by immunising these patients and by prescribing antibiotic prophylaxis. The purpose of our study was to determine compliance with the international standards for the management of splenectomised patients in the Netherlands by investigating: (i) vaccination rates, (ii) the prescription of antibiotics and (iii) information in discharge letters. A retrospective review of the medical records and discharge correspondence of 609 splenectomy patients from 1997 to 2008 was performed. Data were collected from 28 hospitals. Adherence to vaccination guidelines and the prescription of antibiotics were assessed. It was found that 85.4% of post-splenectomy patients received pneumococcal vaccination, 39.4% received Haemophilus influenzae type B and 32.3% received meningococcal group C vaccination. Also, 12.4% of patients were discharged on prophylactic antibiotics. In less than 25% of cases were adequate recommendations regarding post-splenectomy management given to the general practitioner (GP). In the Netherlands, compliance with recommendations for the management of patients after splenectomy is insufficient. Fifteen percent of patients do not receive vaccination against pneumococci and the majority of patients do not receive antibiotic prophylaxis. The development and implementation of a national guideline for splenectomised patients is urgently required.