Latz Christopher A, Lella Srihari, Boitano Laura T, DeCarlo Charles, Feldman Zach, Png C Y Maximilian, Mohebali Jahan, Dua Anahita, Conrad Mark
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
J Vasc Surg. 2021 Oct;74(4):1109-1116. doi: 10.1016/j.jvs.2021.03.035. Epub 2021 Apr 19.
Splenectomy is often performed during open thoracoabdominal aortic aneurysm (TAAA) repair, because capsular tears are common and can be associated with significant bleeding. It is unknown whether splenectomy affects the short- or long-term outcomes after TAAA repair.
All open type I to IV TAAA repairs performed from 1987 to June 2015 were evaluated using a single institutional database. The primary endpoints were in-hospital death, major adverse events (MAE) and long-term survival. The secondary endpoint was hospital length of stay (LOS). All repairs performed for aneurysm rupture were excluded. Univariate analysis was conducted using the Fisher's exact test for categorical variables and the Wilcoxon rank sum test for continuous variables. Logistic and linear multivariable regression were used for the in-hospital endpoints, and survival analyses were performed using Cox proportional hazards modeling and Kaplan-Meier techniques.
A total of 649 patients met the study inclusion criteria. Of the 649 patients, 150 (23%) underwent concurrent splenectomy (CS) and six required emergency splenectomy secondary to bleeding postoperatively, leading to 156 cases of total in-hospital splenectomy. The perioperative mortality rate was 5.2% in the CS group and 5.2% in the non-CS group (P = 1.0). MAE were experienced by 48% of the CS patients compared with 34% of the non-CS patients (P = .003). Multivariable analysis revealed splenectomy was not independently predictive of perioperative death (adjusted odds ratio, 0.95; 95% confidence interval [CI], 0.41-2.23; P = .9). However, splenectomy was independently associated with any MAE (adjusted odds ratio, 1.78; 95% CI, 1.19-2.65; P = .005). Splenectomy was also associated with a longer length of stay (+5.39 days; 95% CI, 1.86-8.92; P = .003). No survival difference was found between the cohorts in the total splenectomy cohort in the unadjusted (log-rank P = 1.0) or adjusted (splenectomy adjusted hazard ratio, 1.02; 95% confidence interval, 0.78-1.35; P = .9).
CS during open TAAA repair did not lead to increased perioperative mortality but did lead to significantly increased perioperative morbidity and longer hospital lengths of stay. We found no difference in long-term survival outcomes when CS was performed. Splenectomy during TAAA repair did not affect long-term survival.
在开放性胸腹主动脉瘤（TAAA）修复术中常进行脾切除术，因为包膜撕裂很常见且可能导致大量出血。目前尚不清楚脾切除术是否会影响TAAA修复术后的短期或长期预后。
利用单一机构数据库对1987年至2015年6月期间进行的所有开放性I至IV型TAAA修复术进行评估。主要终点为住院死亡、主要不良事件（MAE）和长期生存。次要终点为住院时间（LOS）。所有因动脉瘤破裂而进行的修复术均被排除。对分类变量使用Fisher精确检验，对连续变量使用Wilcoxon秩和检验进行单因素分析。对住院终点使用逻辑和线性多变量回归，使用Cox比例风险模型和Kaplan-Meier技术进行生存分析。
共有649例患者符合研究纳入标准。在这649例患者中，150例（23%）同时进行了脾切除术（CS），6例因术后出血需要急诊脾切除术，导致院内全脾切除术共156例。CS组围手术期死亡率为5.2%，非CS组为5.2%（P = 1.0）。48%的CS患者发生了MAE，而非CS患者为34%（P = 0.003）。多变量分析显示，脾切除术并非围手术期死亡的独立预测因素（调整后的优势比为0.95；95%置信区间[CI]为0.41 - 2.23；P = 0.9）。然而，脾切除术与任何MAE独立相关（调整后的优势比为1.78；95% CI为1.19 - 2.65；P = 0.005）。脾切除术还与更长的住院时间相关（延长5.39天；95% CI为1.86 - 8.92；P = 0.003）。在未调整（对数秩P = 1.0）或调整（脾切除术调整后的风险比为1.02；95%置信区间为0.78 - 1.35；P = 0.9）的全脾切除队列中，各队列之间未发现生存差异。
开放性TAAA修复术中的CS不会导致围手术期死亡率增加，但会导致围手术期发病率显著增加和住院时间延长。我们发现进行CS时长期生存结局没有差异。TAAA修复术中的脾切除术不影响长期生存。
