Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up

Abstract

© F e r r a t a S t o r t i F o u n d a t i o nveterans who underwent splenectomy with a follow-up of up to 27 years. In this cohort, we assessed patterns of hospitalization for infections, thromboembolism, and malignancies following splenectomy. Methods Study populationBased on USA census data, an estimated 30 million veterans were entitled to admission to VA hospitals during the study period. 33 The VA database has been previously described. 34,35 In the present study, splenectomized patients were identified from the hospital discharge summary records [coded in the 8 th and 9 th revisions of the USA version of the International Classification of Diseases (ICD): ICD8 45.1, ICD9 41.2, 41.43, 41.5] and were included in the study (n=8,149). To minimize the influence of reverse causality (i.e., undetected cancer requiring the splenectomy), all analyses were restricted to individuals whose first VA discharge with a splenectomy occurred at least 1 year prior to the first hospitalization listing a diagnosis of cancer. Thus, patients were followed from 1 year after their initial hospital discharge until the first discharge diagnosis of infection, thromboembolism, malignancy, death, or end of study, whichever occurred first. The time to develop infection, thromboembolism, or malignancy (i.e., latency) was estimated by subtracting the date of discharge from the first hospitalization listing a splenectomy from the date of the first hospitalization listing a diagnosis of infection, thromboembolism, or malignancy.Dates of death were ascertained from record linkage to Social Security Administration mortality files. With such linkage, death reporting is believed to be 96% complete. 36 Among the 8,149 splenectomized men who were selected for the study, 6,731 were eligible for matching to the National Death Index (alive as of January 1, 1979). In addition, a random sample (n=6,731) of the eligible VA cohort was selected to match these patients on the basis of race and year of birth (1:1 sample). The National Death Index provided death certificate matching for the men who had undergone splenectomy and for the matched controls (n=13,462). Statistical analysisRelative risk (RR) estimates and 95% confidence intervals (CI) were calculated using time-dependent Poisson regression methods for cohort data. 37 Calculations were performed using the AMFIT program (Epicure Version 2.0; HiroSoft International Corporation, Seattle, Washington, USA). All risk estimates were adjusted for attained age (<40, 40-49, 50-59, 60-69, 70-79, 80 or more years) and calendar year (1969-1974, 1975-1979, 1980-1984, 1985-1989, 1990-1996), race (African-American or white), number of hospital visits (1-2, 3-4, 5 or more), and time between study entry and exit (2-3, 4-5, 6-9, 10-14, 15 or more years). Risk estimates for buccal, esophageal, and liver cancers were also adjusted for a hospital discharge diagnosis of alcohol-related disorders because inclusion of this variable in the regression models resulted in a >10% change in the risk estimates. Adj...

Hereditary Spherocytosis - Diagnosis, Surgical Treatment and Outcomes. A Literature Review

“…However, total splenectomy exposes the patient to a life -long risk of potentially lethal infections (17) and thus, its usage was reconsidered. In children less than 5 years old, the risk of overwhelming postsplenectomy sepsis may be increased 60-to 100 fold, compared with that of children without a splenectomy (18) There are also concerns that despite the immunizations against encapsulated bacteria and the postoperative antibiotic prophylaxis, the risk after total splenectomy is never eliminated.…”

“…In children less than 5 years old, the risk of overwhelming postsplenectomy sepsis may be increased 60-to 100 fold, compared with that of children without a splenectomy (18) There are also concerns that despite the immunizations against encapsulated bacteria and the postoperative antibiotic prophylaxis, the risk after total splenectomy is never eliminated. (17,19,20) Because of this reason, a number of alternatives to total splenectomy have been considered, including auto-transplantation of the removed spleen and partial splenectomy. (21) The use of partial splenectomy, particularly in pediatric patients, aims to retain splenic immunologic function, while at the same time to decrease the rate of hemolysis.…”

Autophagic vesicles on mature human reticulocytes explain phosphatidylserine-positive red cells in sickle cell disease

“…Red cells from SCD and splenectomized patients were trypsin-treated and stained with R10, and also found to have elevated levels of internal GPA-decorated vesicles ( Figure 2E-F). We provide evidence indicating that PS-exposed red cells described in SCD and splenectomized individuals [9][10][11][12] are circulating reticulocytes, which cannot be properly processed because the patients lack a functional spleen.…”

Reasons for Inadequate Vaccination after Splenectomy

“…Recent study conducted by Nived et al showed that the number of patients who have received pneumococcal vaccine is lower than the number of patients in our study (81%); however, a larger number of patients received the vaccines against Haemophilus influenzae and meningococcal vaccine (51,9% and 22,8 %, respectively) (12). The importance of vaccination has also been shown by a study conducted in the USA (13). This study showed that splenectomized patients are at higher risk of pneumonia, meningitis and septicemia, even 10 years after splenectomy (13).…”

“…The importance of vaccination has also been shown by a study conducted in the USA (13). This study showed that splenectomized patients are at higher risk of pneumonia, meningitis and septicemia, even 10 years after splenectomy (13). It is alarming that none of the doctors (surgeons, general practitioners) knew about the use of vaccines for Neisseria meningitides and Haemophilus influenzae after splenectomy.…”