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Postsplenectomy sepsis and its mortality rate: actual versus perceived risks
R J Holdsworth1, A D Irving, A Cuschieri
1University Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK.
Insights
Splenectomy (spleen removal) poses a higher sepsis risk in children, especially those under five. Adults face a lower risk, but coexisting conditions like liver disease increase susceptibility in all age groups.
Area of Science:
- Medicine
- Infectious Diseases
- Surgical Outcomes
Background:
- The spleen plays a role in immune function, and its removal (splenectomy) can impact susceptibility to infections.
- Postspleen removal sepsis has been a recognized complication, particularly in pediatric populations.
Purpose of the Study:
- To critically review the literature on postsplenectomy sepsis from 1952 to 1987.
- To analyze the incidence, mortality, and types of infections following splenectomy across different age groups.
Main Methods:
- A collective critical literature review was performed.
- Analysis focused on 5902 detailed reports from a cohort of 12,514 splenectomy patients.
Main Results:
- Infection rates post-splenectomy were 4.4% in children (<16 years) and 0.9% in adults, with corresponding mortality rates of 2.2% and 0.8%.
- Severe infections were rare in adults and older children but notably higher in infants (15.7%) and children under 5 (10.4%).
- Children predominantly developed meningitis, while adults were more prone to fatal septicemia; children showed higher susceptibility to pneumococcal sepsis.
Conclusions:
- Severe postsplenectomy infection is uncommon in adults and older children with benign disease but a significant risk in infants and very young children.
- Age influences the type and outcome of postsplenectomy infections, with children experiencing meningitis and adults septicemia.
- Coexisting conditions, such as hepatic disease, substantially increase the risk of infection after splenectomy.
Abstract:
A collective critical review of the literature on postsplenectomy sepsis from 1952 to 1987 has been undertaken. The reports cover a cohort of 12,514 patients undergoing splenectomy but of these only 5902 reports were sufficiently detailed to allow a useful analysis. The incidence of infection after splenectomy in children under 16 years old was 4.4 per cent with a mortality rate of 2.2 per cent. The corresponding figures for adults were 0.9 per cent and 0.8 per cent respectively. The present analysis of well documented patients has shown that severe infection after splenectomy for benign disease is very uncommon except in infants (infection rate 15.7 per cent) and children below the age of 5 years (infection rate 10.4 per cent). Many of these reported postsplenectomy infections may have been coincidental. It is also apparent that children contract a different type of infection after splenectomy than adults, predominantly a meningitis which is less frequently fatal. Adults, in contrast, appear to develop a septicaemic type of illness associated with a higher mortality rate. This survey has also shown that children are reported to be more susceptible to pneumococcal sepsis than to infection caused by any other organism. Although the removal of the spleen in otherwise normal people does not appear to be associated with an increased frequency of infection, the presence of a coexistent disorder, notably hepatic disease, can increase the risk substantially.
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