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Risks of synchronous gastrointestinal or biliary surgery with splenectomy for hematologic disease
D McAneny1, C P Godek, T E Scott
1Section of Surgical Oncology, Boston University Medical Center, Boston, Mass., USA.
Insights
Performing gastrointestinal (GI) surgery with splenectomy for hematologic diseases significantly increases the risk of intra-abdominal abscess. This combined procedure should be avoided to reduce complications and mortality.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Hematology
Background:
- Splenectomy combined with gastrointestinal (GI) surgery may negatively impact patient outcomes.
- The risks of performing GI surgery concurrently with splenectomy for hematologic conditions are not well-established.
Purpose of the Study:
- To investigate the risks associated with synchronous GI surgery performed alongside splenectomy for hematologic diseases.
Main Methods:
- A retrospective cohort study involving 207 adult patients undergoing splenectomy for hematologic diseases.
- Patients were divided into two groups: splenectomy with concomitant GI/biliary surgery (n=19) and splenectomy alone (n=188).
- Outcomes assessed included mortality, morbidity, postoperative infections, and intra-abdominal abscesses.
Main Results:
- Patients undergoing combined splenectomy and GI/biliary surgery had a higher incidence of intra-abdominal abscesses (p=.002).
- The combined procedure was associated with a 25-fold increased risk of intra-abdominal abscess (OR, 24.7; p=.002).
- Operative mortality and major complications showed a trend towards being higher in the combined surgery group.
Conclusions:
- Synchronous GI or biliary surgery with splenectomy for hematologic disease significantly elevates the risk of intra-abdominal abscess.
- This combined surgical approach should be avoided due to increased risks of complications and potential mortality.
Background:
The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mortality, morbidity, and even survival.
Objective:
To determine the risks of the converse: synchronous GI surgery appended to splenectomy for hematologic diseases.
Design:
Retrospective cohort.
Setting:
Multiple hospitals comprising an affiliated surgical training program.
Patients:
Consecutive sample of 207 adults (mean age, 49 years) with splenectomies for hematologic diseases.
Intervention:
Splenectomy and concomitant GI or biliary surgery (group 1, n=19) and splenectomy alone (group 2, n=188).
Main Outcome Measures:
Length of hospital or intensive care unit stay, later operations, postoperative infections, postoperative abdominal abscess, major complications, and death.
Results:
Preoperative and intraoperative factors were similar in both groups. Operative mortality was 3 of 19 in group 1 and 8 of 188 in group 2 (p=.07). The mean number of major complications tended to be higher in group 1 (1.5 vs 0.5, P=07). Despite no difference between the incidences of overall postoperative infections, patients in group 1 were much more likely to develop an abdominal abscess (4 of 19 vs 3 of 188, P=.002). Logistic regression established that patients undergoing splenectomy and synchronous GI or biliary surgery were 25 times more likely to develop an intra-abdominal abscess than were patients with splenectomy alone, even controlling for confounding factors (odds ratio, 24.7; 95% confidence interval, 3.1 to 196; P=.002).
Conclusions:
Synchronous GI or biliary surgery with splenectomy for hematologic disease increases the risk of intra-abdominal abscess and should be avoided. Complication and mortality rates may also be increased.