Risk factors associated with mortality and morbidity after elective splenectomy.

OBJECTIVE

To assess the effect of certain risk factors on the outcome of elective splenectomy.

DESIGN

Retrospective cohort study.

SETTING

University hospital, Norway.

SUBJECTS

135 patients who underwent elective splenectomy from 1978 to 1992 for autoimmune diseases (n = 58), myeloproliferative disorders (n = 58), and other diagnoses (n = 19).

MAIN OUTCOME MEASURES

Morbidity and mortality, and the effect on outcome of age, malignancy, platelet count, treatment with steroids, and blood transfusion during the operative period.

RESULTS

Three patients died, one from each diagnostic group; all had been treated with steroids. The overall complication rate was 31% (42/135). Most of the complications (31, 74%) were infective (pneumonia n = 23, abscess or sepsis n = 8). Nine patients required reoperation (haemorrhage, n = 6, and wound dehiscence, n = 2, and bowel obstruction, n = 1). Neither treatment with steroids nor severe thrombocytopaenia were risk factors for any complication, but age (p = 0.05) and a diagnosis of myeloproliferative disease (p = 0.08) had an important though not significant role. Blood transfusion during the operative period was the only independent risk factor (p = 0.001), and further analysis showed that transfusion of blood had a dose dependent effect on the incidence of infective complications (chi-square for linear trend 14.21 p < 0.001).

CONCLUSION

To reduce the complication rate of elective splenectomy blood transfusion during the operative period should be avoided.