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Acute Chest Syndrome After Splenectomy in Children With Sickle Cell Disease
Yousef El-Gohary1, Andrew Fleming2, Hui Zhang3
1Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Children with sickle cell disease (SCD) undergoing splenectomy who experienced severe postoperative pain were more likely to develop acute chest syndrome (ACS). This highlights the need for better pain management strategies in SCD patients post-surgery.
Area of Science:
- Pediatric Surgery
- Hematology
- Critical Care Medicine
Background:
- Sickle cell disease (SCD) patients face high risks for severe complications, including acute chest syndrome (ACS), especially after surgery.
- Perioperative factors contributing to postoperative ACS in children with SCD post-splenectomy remain poorly understood.
Purpose of the Study:
- To identify perioperative factors associated with the development of ACS in pediatric SCD patients following splenectomy.
- To improve understanding of ACS risk factors in this vulnerable population.
Main Methods:
- Retrospective review of medical records for children with SCD who underwent splenectomy between 1997 and 2017.
- Comparison of categorical and non-categorical variables using Fisher's exact test and Student's two-tailed t-test, respectively.
Main Results:
- Of 65 pediatric patients with SCD who underwent splenectomy, 10 (15.4%) developed ACS.
- Patients who developed ACS reported significantly higher postoperative pain scores and received more opioid analgesics compared to those who did not.
- Higher pain scores and increased opioid use were strongly correlated with ACS development.
Conclusions:
- Elevated postoperative pain in children with SCD post-splenectomy may indicate early ACS.
- Opioid use for pain management might exacerbate ACS, suggesting a need for non-opioid pain control alternatives.
Background:
Individuals with sickle cell disease (SCD) are at high risk of developing life-threatening complications, particularly acute chest syndrome (ACS) postoperatively. The perioperative factors associated with the development of ACS in children with SCD after splenectomy have not been clearly identified.
Materials And Methods:
We retrospectively reviewed medical records of all children who underwent splenectomy at our institution between 1997 and 2017 with the goal of identifying perioperative factors associated with postoperative ACS. Categorical and noncategorical variables were compared using Fisher's exact test and Student's two-tailed t-test, respectively.
Results:
Sixty-five patients with SCD underwent splenectomy at a median of 4.0 (interquartile range [IQR] 2.0-8.0) years of age. A laparoscopic approach was used for 64 (98.5%) patients. Fifty-six (86.2%) underwent laparoscopic total splenectomy, and eight (12.3%) underwent laparoscopic partial splenectomy, of which two were converted to open. One had an open partial splenectomy (1.5%). Of the 65 patients, 10 (15.4%) developed ACS with a mean time to diagnosis of 49.0 ± 34.5 h. Children who developed ACS had a higher postoperative median pain score of 6.8 (IQR 5.1-9.1) versus 2.7 (IQR 1.6-4.2), P < 0.001, higher median pain score area under the curve 111.5 (IQR 76.9-169.1) versus 47.3 (IQR 30.5-78.3), P = 0.01, and received more total morphine equivalents (median 1.4 [IQR 0.4-2.7] versus 0.5 [IQR 0.3-0.9] mg/kg, respectively; P = 0.003), compared with children who did not develop ACS.
Conclusions:
Significant postoperative pain may be an early sign of ACS that could be worsened by opioid use, supporting the investigation of nonopioid pain control options in this patient population.
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