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Prophylaxis against pneumococcal infection after splenectomy: a challenge for hospitals and primary care
P Ejstrud1, J B Hansen, D A Andreasen
1Department of Gastrointestinal Surgery, Aalborg Hospital, Denmark.
Objective:
To evaluate prophylaxis against pneumococcal infection after splenectomy.
Design:
Retrospective analysis.
Setting:
District hospital, Denmark.
Subjects:
555 Patients who underwent splenectomy between 1 January 1984 and 31 December 1993.
Interventions:
Splenectomy, pneumococcal vaccination.
Main Outcome Measures:
Pneumococcal vaccination rates and the time of vaccination related to different indications for splenectomy. Extent of information in hospital records about measures for prophylaxis against pneumococcal infection. Recording of splenectomy and vaccination in discharge letters.
Results:
The total vaccination rate was 62% (344/555), but vaccination rates from 47% to 91% in five different groups of indications were observed. Patients undergoing splenectomy during cancer surgery or because of inadvertent intraoperative trauma to the spleen were particularly at risk of not being vaccinated. Vaccination rates increased from 59% to 70% during the period studied. Of the 235 patients alive on 1 April 1995, 87% (205) had been vaccinated. Only 23% of the patients were vaccinated at the appropriate time. Splenectomy had not been recorded in 10%, and vaccination status was mentioned in 35% of the discharge letters. Only 6% of the hospital records and 2% of the discharge letters mentioned one or more precautions to consider for asplenic patients.
Conclusions:
The pneumococcal vaccination rates of patients after splenectomy were not satisfactory. Most of patients were vaccinated at an inappropriate time in relation to the splenectomy. The discharge letters often lacked information about the patients' vaccination status. More effort is needed to reach an acceptable level of prophylaxis against pneumococcal infection after splenectomy.