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Acute chest syndrome after abdominal surgery in children with sickle cell disease: Is a laparoscopic approach better?
P W Wales1, E Carver, M W Crawford
1Division of Pediatric General Surgery and Department of Anaesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Abdominal surgery in sickle cell disease (SCD) patients carries a high risk of acute chest syndrome (ACS), with a 20% incidence. Laparoscopic surgery does not appear to reduce this risk compared to open procedures.
Area of Science:
- Medical research
- Surgical outcomes
- Hematology
Background:
- Acute chest syndrome (ACS) is a major cause of mortality in sickle cell disease (SCD).
- Surgery is a known risk factor for ACS development in SCD patients.
- Laparoscopic surgery has been hypothesized to reduce sickle-related complications.
Purpose of the Study:
- To determine the incidence of postoperative ACS in SCD patients undergoing abdominal surgery.
- To identify predisposing factors for ACS after abdominal surgery in SCD patients.
- To compare ACS rates between laparoscopic and open abdominal surgery approaches.
Main Methods:
- Retrospective analysis of SCD patients who underwent abdominal surgery (1994-1998).
- Data collected included demographics, perioperative status, and outcomes.
- Statistical analysis using Student's t test and chi-squared test.
Main Results:
- Overall ACS incidence was 11.3% (7/62), with 20% (7/35) in abdominal cases.
- ACS incidence in laparoscopic abdominal surgery was 22.7% (5/22) vs. 15.4% (2/13) in open cases.
- Longer operating time in laparoscopy; no significant predisposing factors identified, but previous ACS episodes and lack of transfusion were noted.
Conclusions:
- Abdominal surgery poses a significant 20% risk of ACS in sickle cell disease patients.
- Laparoscopic surgery does not reduce the incidence of ACS compared to open surgery.
- Predisposing factors for postoperative ACS remain unclear, highlighting considerable morbidity and cost implications.
Background/Purpose:
Acute chest syndrome (ACS) is the leading cause of hospitalization and death among patients with sickle cell disease (SCD). Surgery is a risk factor for the development of ACS. It has been suggested that laparoscopic surgery could diminish the risk of sickle-related complications; therefore, more procedures may be encouraged in asymptomatic patients. The goal of the authors was to determine the incidence of postoperative ACS and assess for predisposing factors in all sickle cell patients undergoing abdominal surgery.
Methods:
A retrospective analysis of all sickle cell patients receiving abdominal surgery (open and laparoscopic) between 1994 and 1998 was conducted. Data pertaining to demographics, perioperative clinical status, postoperative care, and outcome were collected and analyzed using Student's t test or chi(2) where appropriate.
Results:
Fifty-four children underwent 62 procedures (35 abdominal and 27 extracavitary). All abdominal cases were either cholecystectomy or splenectomy (22 laparoscopic and 13 open). ACS occurred in 7 of 62 (11.3%) overall, and all were in abdominal cases 7 of 35 (20%). ACS occurred in 5 of 22 (22.7%) laparoscopic cases and 2 of 13 (15.4%) open cases. Operating time was significantly longer in the laparoscopic group compared with open cases (P <.05). A higher percentage of patients who had ACS had at least 1 previous episode (71.4% v 39.3%; P value not significant) and a smaller percentage of ACS patients received a preoperative blood transfusion (14.3% v 32.1%; P value not significant). Postoperative hospitalization was prolonged if ACS occurred (9 +/- 2 v 3 +/- 2 days; P <.05).
Conclusions:
Abdominal surgery carries a significantly high risk (20%) of ACS. Laparoscopy does not decrease the incidence of ACS compared with open approach. Predisposing factors were not significant in predicting postoperative ACS. There is considerable morbidity and potential cost implications in patients with ACS.
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