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Outcomes after splenectomy in children: a 48-year population-based study
Mohammad A Khasawneh1, Nicolas Contreras-Peraza1, Matthew C Hernandez1
1Division of Trauma, Critical Care and General Surgery, Department of Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA.
Insights
Most children who have undergone splenectomy do not develop long-term infections. However, those with non-traumatic, non-malignant disease or multiple procedures face higher infection risks. Vaccinations are crucial for post-splenectomy care.
Area of Science:
- Pediatric Surgery
- Infectious Disease Epidemiology
- Immunology
Background:
- Splenectomy in children can impair immune function, increasing infection risk.
- Long-term data on post-splenectomy infection rates and risk factors in pediatric populations are limited.
Purpose of the Study:
- To determine the long-term incidence of and risk factors for infection after splenectomy in children.
- To inform clinical management and preventative strategies for pediatric post-splenectomy patients.
Main Methods:
- Population-based cohort study utilizing the Rochester Epidemiology Project (REP) from 1966-2011.
- Inclusion of all children (<18 years) who underwent splenectomy.
- Statistical analyses included descriptive statistics, Kaplan-Meier estimates, and Cox proportional hazard ratios.
Main Results:
- Ninety pediatric patients underwent splenectomy; indications varied (trauma, hematologic disease, malignancy).
- Nineteen patients developed infections; risk factors identified were non-traumatic/non-malignant disease (HR 4.83) and multiple surgical procedures (HR 2.80).
- Estimated 15- and 20-year infection-free survival rates were 97%.
Conclusions:
- The majority of children do not experience post-splenectomy infections.
- Vaccination rates were 72%, with lower rates in trauma cases.
- Multiple surgical procedures significantly increased infection risk in pediatric splenectomy patients.
Purpose:
In children who have undergone splenectomy, there may be impaired immunologic function and an increased risk of infection. We aimed to define the long-term rate of and risk factors for post-splenectomy infection using a population-based cohort study.
Methods:
All children (< 18 years) who underwent splenectomy from 1966 to 2011 in Olmsted County, MN were identified using the Rochester Epidemiology Project (REP). Descriptive statistics, Kaplan-Meier estimates, and Cox Proportional hazard ratios were performed to evaluate for risk factors associated with developing infection.
Results:
Ninety patients underwent splenectomy and 46% were female. Indications included trauma (42%), benign hematologic disease (33%), malignancy (13%), and other (11%). Most were performed open. Vaccination was completed in (72%) for pneumococcal, H. influenza, and meningococcal vectors. Nineteen patients developed infection, and associated factors included non-traumatic, non-malignant disease [HR 4.83 (1.18-19.85)], and performance of multiple surgical procedures [HR 2.80 (1.09-7.21)]. Estimated survival free of infection rates at 15 and 20 years following surgery was both 97%.
Conclusions:
After splenectomy in children, most patients do not develop infection. Nearly three-quarters of patients were vaccinated with the lowest rates in patients that underwent a splenectomy for trauma. In patients who received multiple procedures during a splenectomy, the infection risk was higher.
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