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Outcomes after splenectomy in children: a 48-year population-based study

  • Mohammad A. Khasawneh
  • Nicolas Contreras-Peraza
  • Matthew C. Hernandez
  • Christine Lohse
  • Donald H. Jenkins
  • Martin D. ZielinskiEmail author
Original Article
  • 32 Downloads

Abstract

Purpose

In children who have undergone splenectomy, there may be impaired immunologic function and an increased risk of infection. We aimed to define the long-term rate of and risk factors for post-splenectomy infection using a population-based cohort study.

Methods

All children (< 18 years) who underwent splenectomy from 1966 to 2011 in Olmsted County, MN were identified using the Rochester Epidemiology Project (REP). Descriptive statistics, Kaplan–Meier estimates, and Cox Proportional hazard ratios were performed to evaluate for risk factors associated with developing infection.

Results

Ninety patients underwent splenectomy and 46% were female. Indications included trauma (42%), benign hematologic disease (33%), malignancy (13%), and other (11%). Most were performed open. Vaccination was completed in (72%) for pneumococcal, H. influenza, and meningococcal vectors. Nineteen patients developed infection, and associated factors included non-traumatic, non-malignant disease [HR 4.83 (1.18–19.85)], and performance of multiple surgical procedures [HR 2.80 (1.09–7.21)]. Estimated survival free of infection rates at 15 and 20 years following surgery was both 97%.

Conclusions

After splenectomy in children, most patients do not develop infection. Nearly three-quarters of patients were vaccinated with the lowest rates in patients that underwent a splenectomy for trauma. In patients who received multiple procedures during a splenectomy, the infection risk was higher.

Keywords

Post-splenectomy Sepsis Splenectomy Population Outcomes 

Notes

Acknowledgements

This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676.

Author contributions

Drs. MAK, NC-P, MCH, DHJ, MDZ, and CL conceptualized and designed the study, designed the data collection instruments, collected data, carried out the initial analyses, drafted the initial manuscript, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all the aspects of the work.

Funding

No funding was utilized for this study.

Compliance with ethical standards

Conflict of interest

Mohammad A. Khasawneh, MBBS declares that he has no conflict of interest, Nicolas Contreras-Peraza, MD declares that he has no conflict of interest, Matthew C. Hernandez, MD declares that he has no conflict of interest, Christine Lohse, MSc declares that she has no conflict of interest, Donald H. Jenkins, MD declares that he has no conflict of interest, and Martin D. Zielinski, MD declares that he has no conflict of interest.

Animal rights

No animals were utilized in this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Mohammad A. Khasawneh
    • 1
  • Nicolas Contreras-Peraza
    • 1
  • Matthew C. Hernandez
    • 1
  • Christine Lohse
    • 2
  • Donald H. Jenkins
    • 1
  • Martin D. Zielinski
    • 1
    Email author
  1. 1.Division of Trauma, Critical Care and General Surgery, Department of SurgerySt. Mary’s Hospital, Mayo ClinicRochesterUSA
  2. 2.Department of Health Science ResearchMayo ClinicRochesterUSA

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