The risk of sepsis in the asplenic adult.

The risk of postsplenectomy sepsis in children is well established. The risk of sepsis following splenectomy in the adult remains unknown. This study provides data on this important subject. All adults (ages 16--91) who underwent splenectomies in three hospitals of the Louisiana State University Medical Center between 1965 and 1975 were identified. There were 298 patients included in the study. Postsplenectomy information was collected on 256 patients. The mean period of observation was 45 months (960 patient years). There were seven deaths from fulminant sepsis (incidence rate: 2.7%). Data were collected on 250 patients who had either a gastrectomy or cholecystectomy without splenectomy. The mean period of observation was 61 months (1270 patient years). There were no deaths due to fulminant sepsis (p less than 0.05). When postsplenectomy sepsis was compared with the risk of sepsis in the population at large (0.001%), the difference is significant (p less than 0.001). In the subgroup of 69 patients with hematologic or malignant disease, there were three deaths from sepsis (4.3%). In 187 patients with no underlying diseases, four patients developed sepsis, which is an incidence of 2.2% (p less than 0.05 when compared with the population at large and control group). The risk of sepsis appears to be greater in patients with chronic disease, but has no relationship to age. These data speak for the conservation of splenic tissue when possible.