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Article |

Risks of Synchronous Gastrointestinal or Biliary Surgery With Splenectomy for Hematologic Disease

David McAneny, MD, FACS; Christopher P. Godek; Thayer E. Scott, MPH; Wayne W. LaMorte, MD, PhD, MPH; Robert M. Beazley, MD, FACS
Arch Surg. 1996;131(4):372-376. doi:10.1001/archsurg.1996.01430160030004.
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Background:  The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mortality, morbidity, and even survival.

Objective:  To determine the risks of the converse: synchronous GI surgery appended to splenectomy for hematologic diseases.

Design:  Retrospective cohort.

Setting:  Multiple hospitals comprising an affiliated surgical training program.

Patients:  Consecutive sample of 207 adults (mean age, 49 years) with splenectomies for hematologic diseases. Intervention: Splenectomy and concomitant GI or biliary surgery (group 1, n=19) and splenectomy alone (group 2, n=188).

Main Outcome Measures:  Length of hospital or intensive care unit stay, later operations, postoperative infections, postoperative abdominal abscess, major complications, and death.

Results:  Preoperative and intraoperative factors were similar in both groups. Operative mortality was 3 of 19 in group 1 and 8 of 188 in group 2 (P=.07). The mean number of major complications tended to be higher in group 1 (1.5 vs 0.5, P=.07). Despite no difference between the incidences of overall postoperative infections, patients in group 1 were much more likely to develop an abdominal abscess (4 of 19 vs 3 of 188, P=.002). Logistic regression established that patients undergoing splenectomy and synchronous GI or biliary surgery were 25 times more likely to develop an intra-abdominal abscess than were patients with splenectomy alone, even controlling for confounding factors (odds ratio, 24.7; 95% confidence interval, 3.1 to 196; P=.002).

Conclusions:  Synchronous GI or biliary surgery with splenectomy for hematologic disease increases the risk of intra-abdominal abscess and should be avoided. Complication and mortality rates may also be increased.(Arch Surg. 1996;131:372-376)


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