Evaluation of factors affecting early and late complications after elective splenectomy

Abstract

We aimed to investigate the factors affecting early and late complications following splenectomy. The potential factors expected to affect postsplenectomy complications included age (?60 vs.<60 years), gender, preoperative diagnosis (malignant vs.benign), vaccination status, surgical technique (laparoscopy vs. open surgery), and spleen size (?15 vs.<15 cm). Postoperative complications were divided into early and late complications. In the evaluation of the factors affecting early and late complications, univariate analyses were performed using the Chi-square test. The factors found to be statistically significant in the univariate analyses were used to determine the independent factors affecting early and late complications by using multivariate logistic regression analysis. The incidence of early complications was significantly higher in the patients with hematological malignancies (p=0.001), patients aged 60 years or over (p=0.014), those who underwent open surgery (p=0.019), and patients with a spleen size of >15 cm (p=0.008), whereas the incidence of late complications was significantly higher in the patients with hematological malignancies (p=0.023) and in the patients that received no prophylactic vaccination (p=0.043). In the logistic regression analysis, the splenectomy performed for hematological malignancies was revealed as the only independent factor increasing the risk of early complications (p=0.042) as well as late complications (p=0.035). In conclusion, the splenectomy performed for hematological malignancies was revealed as the only independent factor increasing the risk of both early and late complications. However, as this factor cannot be reversed or prevented by surgeons, surgeons should instead properly administer preoperative vaccination protocols and should also inform the patients about the future doses of booster vaccination to reduce the risk of postoperative complications. For thromboembolic risks, the routine use of low-molecular-weight heparins both pre-and perioperatively should be promoted. The patients with thromboembolic complications should be closely monitored during the long term following splenectomy.