Research Original Investigation
Morbidity and Mortality Following Elective Splenectomy
Invited Commentary
Elective Splenectomy for Hematologic Diseases Can We Predict Complications? Juan I. Arcelus, MD, PhD
Splenectomy remains a common procedure for the management of certain benign and malignant hematologic diseases. Laparoscopic splenectomy is associated with better outcomes than open splenectomy and has become the standard approach for these conditions.1-3 In this issue of JAMA Surgery, Bagrodia and colleagues4 report their use of the American College of Surgeons National Surgical Quality Improvement Program database to evaluate clinical and pathologic variables associated with 30-day morbidity and mortality afRelated article page 1022 ter elective splenectomy for hematologic diseases. They demonstrate that although the postoperative mortality rate is low, splenectomy is associated with substantial morbidity, particularly in patients operated on for malignant disease. Using multivariable logistic regression analysis, the authors identified several clinical variables that were independent predictors of morbidity and mortality. The incidences of postoperative morbidity and mortality in patients undergoing elective splenectomy described in recent series2,5 are similar to those reported in the study by
Bagrodia et al. Bagrodia and colleagues found a significantly higher rate of complications in patients with malignant disease, but the operative approach was not a predictor of morbidity or mortality. In contrast, Musallam et al,3 also using data from the American College of Surgeons National Surgical Quality Improvement Program, reported that laparoscopic splenectomy was associated with better outcomes than open splenectomy, irrespective of the indication for splenectomy. Bagrodia and coworkers do not provide information on the influence of other factors such as spleen weight or surgeon experience. Additional limitations of their observational study are related to the short follow-up period (30 days), which will underestimate the actual rates of other complications such as venous thromboembolism or postsplenectomy sepsis. Nevertheless, this study provides some potentially useful tools to predict postoperative morbidity and mortality. Because low preoperative albumin level was found to increase mortality, improving patients’ nutritional status could improve outcomes, particularly in the elderly. It would be relevant to try to validate these results in prospective studies.
ARTICLE INFORMATION
REFERENCES
Author Affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Granada, Spain.
1. Grahn SW, Alvarez J III, Kirkwood K. Trends in laparoscopic splenectomy for massive splenomegaly. Arch Surg. 2006;141(8):755-762.
Corresponding Author: Juan I. Arcelus, MD, PhD, Division of General and Gastrointestinal Surgery, Department of Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Ave de Madrid s/n, 18071 Granada, Spain. Published Online: August 20, 2014. doi:10.1001/jamasurg.2014.310.
2. Ahad S, Gonczy C, Advani V, Markwell S, Hassan I. True benefit or selection bias: an analysis of laparoscopic versus open splenectomy from the ACS-NSQIP. Surg Endosc. 2013;27(6):1865-1871. 3. Musallam KM, Khalife M, Sfeir PM, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg. 2013;257(6):1116-1123.
4. Bagrodia N, Button AM, Spanheimer PM, Belding-Schmitt ME, Rosenstein LJ, Mezhir JJ. Morbidity and mortality following elective splenectomy for benign and malignant hematologic conditions: analysis of the American College of Surgeons National Surgical Quality Improvement Program data [published online August 20, 2014]. JAMA Surg. doi:10.1001/jamasurg.2014.285. 5. Taner T, Nagorney DM, Tefferi A, et al. Splenectomy for massive splenomegaly: long-term results and risks for mortality. Ann Surg. 2013;258 (6):1034-1039.
Conflict of Interest Disclosures: None reported.
1030
JAMA Surgery October 2014 Volume 149, Number 10
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a Fudan University User on 05/13/2015
jamasurgery.com
Morbidity and Mortality Following Elective Splenectomy
Invited Commentary
Elective Splenectomy for Hematologic Diseases Can We Predict Complications? Juan I. Arcelus, MD, PhD
Splenectomy remains a common procedure for the management of certain benign and malignant hematologic diseases. Laparoscopic splenectomy is associated with better outcomes than open splenectomy and has become the standard approach for these conditions.1-3 In this issue of JAMA Surgery, Bagrodia and colleagues4 report their use of the American College of Surgeons National Surgical Quality Improvement Program database to evaluate clinical and pathologic variables associated with 30-day morbidity and mortality afRelated article page 1022 ter elective splenectomy for hematologic diseases. They demonstrate that although the postoperative mortality rate is low, splenectomy is associated with substantial morbidity, particularly in patients operated on for malignant disease. Using multivariable logistic regression analysis, the authors identified several clinical variables that were independent predictors of morbidity and mortality. The incidences of postoperative morbidity and mortality in patients undergoing elective splenectomy described in recent series2,5 are similar to those reported in the study by
Bagrodia et al. Bagrodia and colleagues found a significantly higher rate of complications in patients with malignant disease, but the operative approach was not a predictor of morbidity or mortality. In contrast, Musallam et al,3 also using data from the American College of Surgeons National Surgical Quality Improvement Program, reported that laparoscopic splenectomy was associated with better outcomes than open splenectomy, irrespective of the indication for splenectomy. Bagrodia and coworkers do not provide information on the influence of other factors such as spleen weight or surgeon experience. Additional limitations of their observational study are related to the short follow-up period (30 days), which will underestimate the actual rates of other complications such as venous thromboembolism or postsplenectomy sepsis. Nevertheless, this study provides some potentially useful tools to predict postoperative morbidity and mortality. Because low preoperative albumin level was found to increase mortality, improving patients’ nutritional status could improve outcomes, particularly in the elderly. It would be relevant to try to validate these results in prospective studies.
ARTICLE INFORMATION
REFERENCES
Author Affiliation: Division of General and Gastrointestinal Surgery, Department of Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Granada, Spain.
1. Grahn SW, Alvarez J III, Kirkwood K. Trends in laparoscopic splenectomy for massive splenomegaly. Arch Surg. 2006;141(8):755-762.
Corresponding Author: Juan I. Arcelus, MD, PhD, Division of General and Gastrointestinal Surgery, Department of Surgery, Hospital Universitario Virgen de las Nieves, University of Granada, Ave de Madrid s/n, 18071 Granada, Spain. Published Online: August 20, 2014. doi:10.1001/jamasurg.2014.310.
2. Ahad S, Gonczy C, Advani V, Markwell S, Hassan I. True benefit or selection bias: an analysis of laparoscopic versus open splenectomy from the ACS-NSQIP. Surg Endosc. 2013;27(6):1865-1871. 3. Musallam KM, Khalife M, Sfeir PM, et al. Postoperative outcomes after laparoscopic splenectomy compared with open splenectomy. Ann Surg. 2013;257(6):1116-1123.
4. Bagrodia N, Button AM, Spanheimer PM, Belding-Schmitt ME, Rosenstein LJ, Mezhir JJ. Morbidity and mortality following elective splenectomy for benign and malignant hematologic conditions: analysis of the American College of Surgeons National Surgical Quality Improvement Program data [published online August 20, 2014]. JAMA Surg. doi:10.1001/jamasurg.2014.285. 5. Taner T, Nagorney DM, Tefferi A, et al. Splenectomy for massive splenomegaly: long-term results and risks for mortality. Ann Surg. 2013;258 (6):1034-1039.
Conflict of Interest Disclosures: None reported.
1030
JAMA Surgery October 2014 Volume 149, Number 10
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a Fudan University User on 05/13/2015
jamasurgery.com
![[Indication for splenectomy in hematologic diseases].](/assets/img/hold.png)
