Quantifying Infection Risk After Splenectomy

Approximately 22,000 Americans undergo splenectomy annually, usually as a consequence of trauma or to address a hematological disorder. Splenectomy creates life-long risk for overwhelming infections, especially from encapsulated bacteria, and experts estimate that splenectomy patients are 50 times more likely to develop overwhelming infection than others. Younger patients, those with malignancies, and patients with recent (within 2 years) splenectomy are at highest risk of developing overwhelming infection. Researchers from Cedars-Sinai Medical Center, Los Angeles, California, recently quantified the risk for early post-operative infectious complications following traumatic and elective splenectomy. Their study appears in the online version of the journal Surgery.

The researchers employed a retrospective review of prospectively collected data on patients admitted to the surgical intensive care unit (SICU) between January 2011 and July 2013. They compared patients undergoing splenectomy to patients undergoing any other abdominal surgery.

The SICU admitted 1884 patients over the 30 month study period, with 2% (n=33) splenectomy patients and 26% (n=493) abdominal surgery patients among them. The splenectomy and abdominal surgery patients were similar in terms of surgical acuity, age, and past medical history. Splenectomy patients were significantly more likely to have sustained a traumatic injury (30% vs. 7%).

Splenectomy patients were 2.7 times more likely to develop infectious complications than comparator abdominal surgery patients. Nine percent of the splenectomy patients developed intra-abdominal abscess compared to 3% in the comparator group; this represents an elevated risk that is almost 3 times greater than for patients undergoing abdominal surgery.

Patients who underwent splenectomy for trauma had outcomes similar to those who had elective splenectomy; approximately half of these patients experienced infectious complications. One difference was identified in these two groups: 12% of elective splenectomy patients developed abdominal abscess, but no trauma patients did.

The authors confirm that splenectomy increases the risk for post-operative infectious complications, and they urge further study to identify strategies that could decrease associated morbidity.