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Predictors of Complications after Elective Splenectomy
*Ali Ardestani, *Roger T Lis, *Eric Sheu, Ali Tavakkoli
Brigham and Women's Hospital, Boston, MA

Objective: We studied outcomes of elective splenectomy to identify those at risk of poor surgical outcomes. We calculated White Cell Count (WCC) ratio and studied the utility of this ratio in predicting complications.
Design: Retrospective Cohort
Setting: Academic Center
Patients: Patients who have undergone elective Splenectomy between 1997 to 2014 were divided to those undergoing surgery due to hematological malignancies (LMP group) or benign hematological disorders and splenic lesions (SPL group).
Interventions:Elective Splenectomy
Main Outcome Measures: Post-operative WCC changes expressed as a ratio and correlation of this ratio to surgical Morbidity and Mortality
Results: We identified 422 patients, 158 (37%) in the SPL group and 264 (63%) in the LMP group (Table 1). Morbidity and mortality were significantly higher in the LMP group (p<0.01). In multivariate analysis controlling for age, sex, BMI, splenic weight, surgical approach, and EBL, indication for surgery was the most significant predictor of complications (OR= 4.1 for LMP group, p <0.001). Looking for ways to identify those at risk of complications, we trended WCC of patients and expressed it as a ratio to immediate post-operative values. Patients experiencing a complication had an increase in WCC ratio in contrast to non-complicated cases (1.3 fold increase vs. 1.1 on POD#2 (p=0.04)).
Conclusions: Splenectomy in patients with LMP is associated with a 4 fold increase in morbidity. Those that develop a complication have increased WCC ratio on POD2. This early marker can be used to identify at risk patients and help guide enhanced surveillance, discharge planning and follow up.
Table 1. Demographics and outcomes of SPL Vs. LMP group.
SPL Group (n=158)LMP Group (n=264)P-Value
Age (years)4561<0.01
Sex (% female)6646<0.01
BMI (Kg/m2)2526<0.01
Estimated Blood Loss (cc)150300<0.01
Operative Time (minutes)111107NS
Drain (%)3530NS
Laparoscopic (%)6023<0.01
Length of Stay (days)34<0.01
Splenic Weight (gr)1901219<0.01
Morbidity Rate (%)8.931.1<0.05
Infection Rate (%)1.312.9<0.01
Thromboembolic Event Rate (%)5.18.0NS
Mortality Rate (%)0.04.2<0.01


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