Risks of synchronous gastrointestinal or biliary surgery with splenectomy for hematologic disease
| Autor: | Robert M. Beazley, Wayne W. LaMorte, David McAneny, Thayer E. Scott, Christopher P. Godek |
|---|---|
| Rok vydání: | 1996 |
| Předmět: |
Adult
Male medicine.medical_specialty Abdominal Abscess medicine.medical_treatment Splenectomy law.invention Postoperative Complications law Risk Factors medicine Humans Digestive System Surgical Procedures Retrospective Studies Analysis of Variance business.industry Mortality rate Retrospective cohort study Odds ratio Middle Aged medicine.disease Intensive care unit Hematologic Diseases Surgery Biliary Tract Surgical Procedures Hematologic disease Regression Analysis Female business |
| Zdroj: | Archives of surgery (Chicago, Ill. : 1960). 131(4) |
| ISSN: | 0004-0010 |
| Popis: | Background: The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mortality, morbidity, and even survival. Objective: To determine the risks of the converse: synchronous GI surgery appended to splenectomy for hematologic diseases. Design: Retrospective cohort. Setting: Multiple hospitals comprising an affiliated surgical training program. Patients: Consecutive sample of 207 adults (mean age, 49 years) with splenectomies for hematologic diseases. Intervention: Splenectomy and concomitant GI or biliary surgery (group 1, n=19) and splenectomy alone (group 2, n=188). Main Outcome Measures: Length of hospital or intensive care unit stay, later operations, postoperative infections, postoperative abdominal abscess, major complications, and death. Results: Preoperative and intraoperative factors were similar in both groups. Operative mortality was 3 of 19 in group 1 and 8 of 188 in group 2 ( P =.07). The mean number of major complications tended to be higher in group 1 (1.5 vs 0.5, P =.07). Despite no difference between the incidences of overall postoperative infections, patients in group 1 were much more likely to develop an abdominal abscess (4 of 19 vs 3 of 188, P =.002). Logistic regression established that patients undergoing splenectomy and synchronous GI or biliary surgery were 25 times more likely to develop an intra-abdominal abscess than were patients with splenectomy alone, even controlling for confounding factors (odds ratio, 24.7; 95% confidence interval, 3.1 to 196; P =.002). Conclusions: Synchronous GI or biliary surgery with splenectomy for hematologic disease increases the risk of intra-abdominal abscess and should be avoided. Complication and mortality rates may also be increased. (Arch Surg. 1996;131:372-376) |
| Databáze: | OpenAIRE |
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