SAN DIEGO – The overall 30-day morbidity rate following surgery for elective splenectomy for hematologic disorders is 13.6% while the overall 30-day mortality rate is 1.6%, results from an analysis of national data demonstrated.
While the morbidity rate was significantly higher for patients with malignant versus benign disease (19.6% vs. 11.9%, respectively), the mortality rate was similar between the two patient groups, Mary Belding-Schmitt reported at the American College of Surgeons/National Surgical Quality Improvement Program National Conference.
"There are limited data regarding complications and mortality following elective splenectomy, especially for malignant disease," said Ms. Belding-Schmitt, a staff nurse in the division of surgical oncology and endocrine surgery in the department of surgery at University of Iowa Hospitals and Clinics. "Most of the published studies are from single institution series and focus on primary splenic diseases. More recent data report a wide range of complications and mortality across different diseases treated with splenectomy."
Mary Belding-Schmitt
In an effort to evaluate complications and mortality following elective splenectomy for benign and malignant hematologic disorders, she and her associates searched the ACS NSQIP database for patients who underwent elective splenectomy procedures from 2006 to 2011. Benign disease was defined as hemolytic anemia or thrombocytopenia, while malignant disease was defined as leukemia or lymphoma. The researchers excluded cases of nonelective splenectomy or splenectomy combined with another procedure. Perioperative clinicopathologic variables and operative complications were analyzed and compared between patients treated for benign and malignant hematologic disease.
Of the 4,859 splenectomy procedures identified from the data set, 1,762 cases met criteria for analysis. Of these, 1,379 operations were for benign conditions while 383 were for malignant conditions. Of the benign indications for splenectomy, most (73.5%) were for thrombocytopenia, 11.7% were for hemolytic anemia, and the remainder were for other conditions. Of the malignant indications for splenectomy, most (83.6%) were for lymphoma and 16.4% were for leukemia.
Patients with benign disease tended to be younger (a mean of 50 vs. 61 years, respectively), were more commonly female (58% vs. 43%), tended to be diabetic (15% vs. 12%), had a higher body mass index (a mean of 29.7 kg/m2 vs. 27.3 kg/m2), received preoperative steroids (60% vs. 13%), and underwent significantly more laparoscopic procedures (82% vs. 39%; P less than .0001).
Ms. Belding-Schmitt reported that the rate of overall complications was significantly higher for patients with malignant vs. benign disease (19.6% vs. 11.9%, respectively; P = .0002), but there was no significant difference between the two groups in overall mortality (2.1% vs. 1.5%; P = .37). She characterized the 2.1% mortality rate as being similar to that following pancreatectomy in high-volume centers.
Patients with malignant disease tended to have a higher rate of infection complications (16% vs. 9%; P = .0002) and a longer median hospital length of stay (5 vs. 3 days; P = .0005).
Ms. Belding-Schmitt said that a multivariable analysis is underway to determine specific variables which account for significant morbidity and mortality from splenectomy for hematologic disorders. She said she had no relevant financial disclosures.