Risk factors associated with mortality and morbidity after elective splenectomy

Abstract

Objective: To assess the effect of certain risk factors on the outcome of elective splenectomy.

Design: Retrospective cohort study.

Setting: University hospital, Norway.

Subjects: 135 patients who underwent elective splenectomy from 1978 to 1992 for autoimmune diseases (n = 58), myeloproliferative disorders (n = 58), and other diagnoses (n = 19).

Main outcome measures: Morbidity and mortality, and the effect on outcome of age, malignancy, platelet count, treatment with steroids, and blood transfusion during the operative period.

Results: Three patients died, one from each diagnostic group; all had been treated with steroids. The overall complication rate was 31% (42/135). Most of the complications (31, 74%) were infective (pneumonia n = 23, abscess or sepsis n = 8). Nine patients required reoperation (haemorrhage, n = 6, and wound dehiscence, n = 2, and bowel obstruction, n = 1). Neither treatment with steroids nor severe thrombocytopaenia were risk factors for any complication, but age (p = 0.05) and a diagnosis of myeloproliferative disease (p = 0.08) had an important though not significant role. Blood transfusion during the operative period was the only independent risk factor (p = 0.001), and further analysis showed that transfusion of blood had a dose dependent effect on the incidence of infective complications (chi-square for linear trend 14.21 p < 0.001).

Conclusion: To reduce the complication rate of elective splenectomy blood transfusion during the operative period should be avoided.