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Updated: Feb 7, 2026
Robot-assisted Partial Splenectomy
Published on: January 2, 2026
Incidence and risk factors for sepsis after childhood splenectomy
Arin L Madenci1, Lindsey B Armstrong2, Nicollette K Kwon3
1Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; The Center for Surgery and Public Health, Boston, MA, United States.
Insights
Children undergoing splenectomy face a 7% risk of sepsis, with most cases occurring after the first year. Older age at splenectomy may reduce sepsis risk. Post-splenectomy immune dysfunction requires ongoing attention.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Immunology
Background:
- Children who have undergone splenectomy (surgical removal of the spleen) are at increased risk of serious infections.
- Overwhelming postsplenectomy infection (OPSI) is a significant concern in asplenic individuals.
- This study aimed to determine the long-term incidence and risk factors for sepsis in children after splenectomy.
Purpose of the Study:
- To define the long-term rate of postsplenectomy sepsis in children.
- To identify risk factors associated with developing sepsis after splenectomy in pediatric patients.
- To assess the temporal distribution of sepsis events post-splenectomy.
Main Methods:
- A retrospective cohort study utilizing the Military Health System Data Repository (2005-2014).
- Included over 3 million children, with a focus on 195 who underwent splenectomy at age 18 or younger.
- Primary outcome was hospitalization for sepsis; survival analysis was used to identify risk factors.
Main Results:
- The incidence of postsplenectomy sepsis was 7% (1.8 events per 100 person-years) in the cohort.
- The median time to sepsis was 224 days, with 38% of events occurring in the first year post-surgery.
- Older age at splenectomy was associated with a reduced hazard of sepsis (HR=0.90 per year).
Conclusions:
- Postsplenectomy sepsis remains a serious concern in children, with a 7% prevalence in this national cohort.
- While many sepsis events occur within the first year, a significant proportion (62%) occur later, indicating persistent immunologic dysfunction.
- The long-term immunologic consequences of asplenia necessitate continued vigilance and management strategies.
Background:
Children who have undergone splenectomy may develop impaired immunologic function and heightened risk of overwhelming postsplenectomy infection. We sought to define the long-term rate of and risk factors for postsplenectomy sepsis.
Methods:
We leveraged the Military Health System Data Repository, a nationally representative claims database including >3 million children registered as dependents of members of the United States Armed Services (2005-2014). Inclusion criterion was splenectomy at age 18 years or prior. The primary outcome was hospitalization for sepsis.
Results:
Among 195 children who underwent splenectomy, 7% (n = 13) were hospitalized with sepsis, with an incidence of 1.8 (95% CI = 1.0-3.1) events per 100 person-years. The median time to sepsis was 224 days (IQR = 109-606) and 38% (5/13) of events occurred within the first postsplenectomy year. The postsplenectomy mortality rate was 1% (n = 3). After adjusting for underlying diagnosis, older age at splenectomy (HR = 0.90 per year, 95% CI = 0.81-0.99) was associated with decreased hazard of sepsis.
Conclusions:
In a contemporary national cohort, the prevalence of postsplenectomy sepsis was 7% (1.8 events per 100 person-years). Although most presented during the first year after splenectomy, many (62%) sepsis events occurred later, suggesting that postsplenectomy immunologic dysfunction persists beyond one year. The immunologic consequences of asplenia must continue to be acknowledged, as postsplenectomy sepsis remains a serious concern.
Type Of Study:
Prognosis study.
Level Of Evidence:
Level III.
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