Elective Splenectomy Risky for Some

By David Douglas

August 29, 2014

NEW YORK (Reuters Health) - Although elective splenectomy is often thought of as a minor procedure, it may be risky for certain patients, according to new findings.

"Our study demonstrates that patients with advanced age, poor performance and nutritional status, and malignant disease are at high risk for complications and death from elective splenectomy," Dr. James J. Mezhir from the University of Iowa Hospitals and Clinics in Iowa City told Reuters Health by email.

In a paper online August 20 in JAMA Surgery, Dr. Mezhir and colleagues note that the operation is frequently performed laparoscopically; however, some patients still undergo open splenectomy. And although splenectomy has been shown to be a safe and effective approach in many patients, information from large studies is lacking.

To investigate further, the researchers examined national data on elective splenectomy for hematologic conditions from 2005 to 2011 and identified 1,715 patients eligible for inclusion.

Of these, 1344 (78.4%) were operated on for benign disease and 371 patients (21.6%) for malignant disease. A total of 291 (17%) had complications and 27 patients died, giving an operative mortality rate of 1.6%. Follow-up was for 30 days.

The overall complication rate was significantly higher for patients with malignant disease than those without (27.2% versus 14.1%).

Among independent predictors of complications were malignant disease (odds ratio, 1.86) and independent as compared to dependent pre-operative functional status (OR, 0.33).

Increasing age was a borderline significant independent predictor of mortality (OR, 1.03; p=0.05), while increasing albumin level predicted a significantly lower risk of operative death (OR, 0.63).

"These variables may be used in combination with the clinical indications for elective splenectomy to help guide decision making in patients with benign and malignant hematologic disorders," Dr. Mezhir concluded.

According to him and his colleagues, "a patient older than 60 years with a low preoperative albumin level has a predicted probability for operative death as high as 10.0%."

In an accompanying editorial, Dr. Juan I. Arcelus highlights some shortcomings of the study, but says it "provides some potentially useful tools to predict postoperative morbidity and mortality."

In an email to Reuters Health, he said the findings show splenectomy "is associated with substantial morbidity, particularly in patients operated on for malignant disease."

Dr. Arcelus, of the University of Granada, Spain concludes his editorial by noting that, "Because low preoperative albumin level was found to increase mortality, improving patients' nutritional status could improve outcomes, particularly in the elderly. It would be relevant to try to validate these results in prospective studies."

SOURCE: http://bit.ly/1tey8IT

JAMA Surg 2014.


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