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Severe late postsplenectomy infection
G L Cullingford1, D N Watkins, A D Watts
1Department of Surgery, University of Western Australia, Nedlands.
Abstract:
In all, 1490 patients underwent splenectomy in Western Australia between 1971 and 1983, giving 7825 person years exposure. Thirty-three patients developed severe late postsplenectomy infection (septicaemia, meningitis or pneumococcal pneumonia requiring hospitalization) and three developed overwhelming postsplenectomy infection. The incidence and mortality rates of severe late postsplenectomy infection were 0.42 and 0.08 per 100 person years exposure respectively and for overwhelming postsplenectomy infection the incidence and mortality rates were 0.04 per 100 person years exposure. There were 628 splenectomies after trauma, giving 3922 person years exposure. Eight patients developed severe late postsplenectomy infection of whom one had overwhelming postsplenectomy infection. Following trauma, the incidence of severe late postsplenectomy infection was 0.21 per 100 person years exposure, with the incidence and mortality rates of overwhelming postsplenectomy infection being 0.03 per 100 person years exposure. Patients undergoing splenectomy have a 12.6-fold increased risk of developing late septicaemia compared with the general population. Splenectomy following trauma gives an 8.6-fold increased risk of late septicaemia. The majority of severe late postsplenectomy infections did not occur within the first 2 years and 42 per cent of severe late postsplenectomy infections occurred greater than 5 years after splenectomy. The low incidence of severe late postsplenectomy infection and overwhelming postsplenectomy infection makes statistical evaluation of the effectiveness of prophylactic antibiotics, vaccination and splenic repair most difficult.
Insights
Patients undergoing splenectomy face a significantly increased risk of severe late infections, particularly septicaemia, even years after the procedure. This highlights the ongoing need for vigilance and preventative strategies post-splenectomy.
Area of Science:
- Surgical Outcomes
- Infectious Diseases
- Public Health
Background:
- Splenectomy, the surgical removal of the spleen, is performed for various medical reasons, including trauma and hematologic disorders.
- The spleen plays a crucial role in the immune system, particularly in defending against encapsulated bacteria.
- Post-splenectomy infection remains a significant concern for affected patients.
Purpose of the Study:
- To determine the incidence and mortality rates of severe late postsplenectomy infections.
- To assess the long-term risks of infection following splenectomy, both for general indications and specifically after trauma.
- To evaluate the temporal pattern of infection development after splenectomy.
Main Methods:
- Retrospective cohort study analyzing splenectomy cases in Western Australia from 1971 to 1983.
- Inclusion of 1490 patients with a total of 7825 person-years of follow-up.
- Calculation of incidence and mortality rates for severe late and overwhelming postsplenectomy infections.
Main Results:
- Overall incidence of severe late postsplenectomy infection was 0.42 per 100 person-years, with a mortality rate of 0.08.
- Patients undergoing splenectomy have a 12.6-fold increased risk of late septicaemia compared to the general population.
- 42% of severe infections occurred more than 5 years post-splenectomy, indicating a prolonged risk period.
Conclusions:
- Splenectomy significantly elevates the risk of severe late infections, including septicaemia, meningitis, and pneumonia.
- The risk of infection persists for many years after splenectomy, with a notable proportion of cases occurring beyond the 5-year mark.
- The low incidence of these severe infections complicates the statistical evaluation of preventative measures like antibiotics, vaccinations, and splenic repair.