Outcomes and complications after splenectomy for hematologic disorders

• Published in: The American journal of surgery 2012-12, Vol.204 (6), p.1014-1020
• Main Authors: Patel, Nirav Y., M.D, Chilsen, Abigail M, Mathiason, Michelle A., M.S, Kallies, Kara J., B.A, Bottner, Wayne A., M.D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anemia, Hemolytic, Autoimmune - surgery; Autoimmune hemolytic anemia; Biological and medical sciences; Blood; Blood platelets; Child; Complications; Disease; Drug therapy; Female; Follow-Up Studies; General aspects; Hematologic and hematopoietic diseases; Humans; Immune thrombocytopenic purpura; Incidence; Kaplan-Meier Estimate; Laparoscopy; Liver, biliary tract, pancreas, portal circulation, spleen; Logistic Models; Male; Medical sciences; Middle Aged; Mortality; Pediatrics; Platelet diseases and coagulopathies; Postoperative Complications - epidemiology; Postoperative outcomes; Postoperative period; Purpura, Thrombocytopenic, Idiopathic - surgery; Recurrence; Retrospective Studies; Splenectomy; Splenectomy - methods; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Young Adult
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.05.030

Abstract Background Splenectomy is generally a second-line therapy in patients with immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AHA) refractory to medical therapy. Our objective was to evaluate outcomes after splenectomy for these disorders. Methods A retrospective review of the medical records of patients who underwent splenectomy for ITP or AHA from January 1, 1996, to December 31, 2010 was completed. Results Sixty patients met the study criteria: 45 with ITP and 15 with AHA. The mean age was 49.4 ± 21.7 years; 63% were women. Initially, 91% and 93% of ITP and AHA patients experienced a complete response ( P = .999); however, 17% of ITP and 29% of AHA patients relapsed ( P = .443). Sixty-four percent of patients responded after relapse for a complete response rate of 85% (82% in ITP and 93% in AHA, P = .427). Thirty-day and long-term complication rates were 10% and 5%, respectively. There were no splenectomy-related 30-day mortalities. Conclusions Splenectomy for ITP and AHA resulted in favorable response rates with low morbidity and is an effective adjunct in the management course of patients failing to achieve or sustain responses with medical therapy.