Management of patients undergoing splenectomy in an Irish teaching hospital: impact of guidelines
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Overwhelming post-splenectomy infection (OPSI) has a 50–70% mortality rate and carries a lifetime risk for the asplenic patient. Specific British guidelines have been developed to reduce its incidence.
To determine whether British guidelines were being followed in our own institution and what impact they had on overwhelming post-splenectomy infection.
Retrospective chart review of 100 splenectomies performed by Department of Surgery, Beaumont Hospital from January 1990 to January 2000.
Twenty per cent of patients were discharged without any recommended vaccinations. Prophylactic antibiotics were not prescribed in 53% of patients. Just 12% of charts document a verbal explanation of the complications and management of asplenia to the patient. Overall septic mortality was 12%, of whom 8% died in hospital and 4% after discharge.
Management of the asplenic patient has improved but is far from complete. A central register of asplenic patients and national asplenic guidelines should be established in Ireland to ensure optimum patient care.
KeywordsAntibiotic Prophylaxis Abdominal Aortic Aneurysm Irish Journal Pneumococcal Vaccine Beaumont Hospital
- 4.Working Party of British Committee for Standards in Haematology. Guidelines for prevention and treatment of infection with an absent or dysfunctional spleen.BMJ 1996; (312): 430–34.Google Scholar
- 5.Davies JM, Barnes R, Milligan D. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen.Clin Med JRCPL; 2: 440–43.Google Scholar
- 7.Acs G, Furka A, Lesznyak T et al. Surgical consequences of the polytrauma equivalent syndrome to the spleen injuries treatment.Eur Surg Res 2002; 34: 1–99.Google Scholar
- 13.Pickering J, Campbell H. An audit of the vaccination an antibiotic prophylaxis practice amongst patients splenctomised in Lothian.Health Bull 2000; 59: 390–95.Google Scholar
- 15.Hazelwood M, Kumararatne DS. The spleen: who needs it anyway?Clin Exp Immunol 1992; 82: 327–29.Google Scholar
- 18.Anonymous. Prevention of pneumococcal disease: recommendations of the advisory committee on immunisation practices (ACIP).Morb Mortal Wkly Rep 1997; 46: 1–24.Google Scholar
- 19.Siber GR, Weitzman SA, Aisdenberg AC. Antibody response of patients with Hodgkins disease to protein and polysaccharide antigena.Rev Infect Dis 1981; 3: 144–59.Google Scholar
- 22.Department of Health. Immunisation against infectious disease. London: HMSO, 1992: 102.Google Scholar
- 29.Maiman LA, Becker MH, Liptak et al. Improving pediatricians compliance enhancing practices. A randomised trial.Am J Dis Children 1998; 142: 773–9.Google Scholar
- 30.Palejwala AA, Hong LYC, King D. Under half of doctors know that antibiotic prophylaxis should be life-long.BMJ (312): 656–60.Google Scholar
- 31.European Antimicrobial Resistance Surveillance System (EARSS). EARSS activities and updates.Eurosurveillance 2001, Vol. 6; 1.Google Scholar
- 32.Spickett GP, Bullimore J, Wallis J, Smith S, Saunders P. Northern Region asplenia register-analysis of first two years.J Clin Pathol 1999 (52): 424–29.Google Scholar