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Splenectomy sequelae: an analysis of infectious outcomes among adults in Victoria

Claire Dendle, Vijaya Sundararajan, Tim Spelman, Damien Jolley and Ian Woolley
Med J Aust 2012; 196 (9): 582-586. || doi: 10.5694/mja11.10909

Summary

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 ≥ 50 years (1.9 per 100 person-years; 95% CI, 1.6–2.7) 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.

  • Claire Dendle1,2
  • Vijaya Sundararajan2
  • Tim Spelman3,4
  • Damien Jolley4
  • Ian Woolley1,2

  • 1 Department of Infectious Diseases, Monash Medical Centre, Southern Health, Melbourne, VIC.
  • 2 Department of Medicine, Monash University, Melbourne, VIC.
  • 3 Centre for Population Health, Burnet Institute, Melbourne, VIC.
  • 4 School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC.

Correspondence: claire.dendle@monash.edu

Acknowledgements: 

Our work was supported by a grant from the Victorian Trauma Foundation.

Competing interests:

No relevant disclosures.

  • 1. Morris DH, Bullock FD. The importance of the spleen in resistance to infection. Ann Surg 1919; 70: 513-521.
  • 2. Standage BA, Goss JC. Outcome and sepsis after splenectomy in adults. Am J Surg 1982; 143: 545-548.
  • 3. Bisharat N, Omari H, Lavi I, Raz R. Risk of infection and death among post-splenectomy patients. J Infect 2001; 43: 182-186.
  • 4. Green JB, Shackford SR, Sise MJ, Powell RW. Postsplenectomy sepsis in pediatric patients following splenectomy for trauma: a proposal for a multi-institutional study. J Pediatr Surg 1986; 21: 1084-1086.
  • 5. Australian Government Department of Health. The international statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM). 4th ed. Sydney: National Centre for Classification in Health, 2004
  • 6. El-Alfy MS, El-Sayed MH. Overwhelming postsplenectomy infection: is quality of patient knowledge enough for prevention? Hematol J 2004; 5: 77-80.
  • 7. Spelman D, Buttery J, Daley A, et al; Australasian Society for Infectious Diseases. Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med J 2008; 38: 349-356.
  • 8. Kyaw MH, Holmes EM, Toolis F, et al. Evaluation of severe infection and survival after splenectomy. Am J Med 2006; 119: 276.e1-7.
  • 9. Schwartz PE, Sterioff S, Mucha P, et al. Postsplenectomy sepsis and mortality in adults. JAMA 1982; 248: 2279-2283.
  • 10. Thomsen RW, Schoonen WM, Farkas DK, et al. Risk for hospital contact with infection in patients with splenectomy: a population-based cohort study. Ann Intern Med 2009; 151: 546-555.
  • 11. Cullingford GL, Watkins DN, Watts AD, Mallon DF. Severe late postsplenectomy infection. Br J Surg 1991; 78: 716-721.
  • 12. Yong M, Thomsen RW, Schoonen WM, et al. Mortality risk in splenectomised patients: a Danish population-based cohort study. Eur J Intern Med 2010; 21: 12-16.
  • 13. Ejstrud P, Kristensen B, Hansen JB, et al. Risk and patterns of bacteraemia after splenectomy: a population-based study. Scand J Infect Dis 2000; 32: 521-525.
  • 14. Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg 1991; 78: 1031-1038.
  • 15. Deodhar HA, Marshall RJ, Barnes JN. Increased risk of sepsis after splenectomy. BMJ 1993; 307: 1408-1409.
  • 16. Waghorn DJ, Mayon-White RT. A study of 42 episodes of overwhelming post-splenectomy infection: is current guidance for asplenic individuals being followed? J Infect 1997; 35: 289-294.
  • 17. Ellison EC, Fabri PJ. Complications of splenectomy. Etiology, prevention, and management. Surg Clin North Am 1983; 63: 1313-1330.
  • 18. Rice HM, James PD. Ectopic splenic tissue failed to prevent fatal pneumococcal septicaemia after splenectomy for trauma. Lancet 1980; 1: 565-566.
  • 19. Denholm JT, Jones PA, Spelman DW, et al. Spleen registry may help reduce the incidence of overwhelming postsplenectomy infection in Victoria. Med J Aust 2010; 192: 49-50. <MJA full text>
  • 20. Singer DE, Albers GW, Dalen JE, et al. Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6 Suppl): 546S-592S.

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