Abstract

OBJECTIVE
To determine the risk and timing of a broad range of infective outcomes and mortality after splenectomy.Design, setting and participants: Analysis of a non-identifiable linked hospital discharge administrative dataset for splenectomy cases between July 1998 and December 2006 in Victoria, Australia.
MAIN OUTCOME MEASURES
Age, sex, indication for splenectomy, infectious events and death. Patients splenectomised for trauma were compared with patients splenectomised for other indications. Infectious risk was established using Cox proportional hazards models.
RESULTS
A total of 2574 patients underwent splenectomy (with 8648 person-years follow-up). Paediatric cases were excluded, leaving 2472 adult cases for analysis. The most common reasons for splenectomy were trauma (635 [25.7%]) and therapeutic haematological indications (583 [23.6%]). After splenectomy, 644 adult patients (26.0%) had a severe infection, with a rate of 8.0 per 100 person-years (95% CI, 7.2-8.4). The risk of severe infection was highest among patients aged > [corrected] 50 years (10.1 [corrected] per 100 person-years; 95% CI, 9.3-11.1) [corrected] and those splenectomised for malignancy (14.2 per 100 person-years; 95% CI, 11.8-17.1). Gram-negative infections represented the most frequent causative organism group accounting for 698 (51%) of bacterial pathogens. Staphylococcus aureus was the second most common causative organism.
CONCLUSION
The incidence of severe infection and all-cause mortality differed according to age and underlying reason for splenectomy, and was highest among the elderly and those with malignancy, and was lowest among trauma patients. This highlights the need for targeted prevention programs.

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Publisher Full Text

Authors

Dendle C, Sundararajan V, Spelman T, Jolley D, Woolley I

Institution

Department of Infectious Diseases, Monash Medical Centre, Southern Health, Melbourne, VIC. claire.dendle@monash.edu

Source

The Medical journal of Australia 196:9 2012 May 21 pg 582-6

MeSH

Adult
Age Factors
Aged
Bacterial Infections
Female
Follow-Up Studies
Gram-Negative Bacterial Infections
Humans
Incidence
Male
Middle Aged
Postoperative Complications
Proportional Hazards Models
Risk Factors
Splenectomy
Staphylococcal Infections
Time Factors
Victoria

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22621150