Nationwide outcomes of nontrauma splenectomy

Zemlyak, Alla; Colavita, Paul D.; Augenstein, Vedra A.; Walters, Amanda L.; Lincourt, Amy E.; Sing, Ronald F.; Heniford, B. Todd

doi:10.1007/s00464-013-3287-7

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…1,5 Previous studies have established that elective splenectomy for malignant conditions has a higher complication rate than splenectomy for benign conditions. 3,5,6 Our study validates the risk factors associated with infectious complications from previous studies. 1,5 In our analysis, the adjusted risk for postoperative septic events remains similar between the group undergoing splenectomy for malignant indications and the group undergoing splenectomy for benign indications.…”

supporting

confidence: 86%

“…4,5 Splenectomy has also been established as a leading cause of thrombotic events in beta-thalassemia patients, owing to the role of the spleen in scavenging thrombogenic red blood cells and to increased numbers of activated platelets in splenectomized patients. 5,6 Iron overload (serum ferritin ≥800-1000 μg/L) in these patients has also been associated with high thrombosis rates, in view of the damaging effects of toxic iron species on the endothelium and vasculature, as well as to secondary development of multiorgan failure (heart, liver, and endocrine dysfunction). 5,7 Advancing age prolongs the exposure of patients to these risk factors, and higher rates of thrombosis have been reported in older beta-thalassemia patients (>35 years).…”

Section: Development Of a Thalassemia-related Thrombosis Risk Scoringmentioning

confidence: 99%

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Disparities in the risk of septic events in patients undergoing splenectomy for hematological malignancies (D‐ROSE‐PUSH): A study based on ACS‐NSQIP database

et al. 2019

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supporting

confidence: 86%

Section: Development Of a Thalassemia-related Thrombosis Risk Scoringmentioning

confidence: 99%

Disparities in the risk of septic events in patients undergoing splenectomy for hematological malignancies (D‐ROSE‐PUSH): A study based on ACS‐NSQIP database

et al. 2019

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“…The Luft paper launched a substantial literature on the volume‐outcome relationship. It also prompted regionalization for certain operative procedures . Regionalization of adrenalectomies to high volume centers has been documented and was associated with reduced inpatient mortality .…”

Section: The Era Of Big Data Beginsmentioning

confidence: 99%

“…Colavita and colleagues found that regionalizing ventral hernia repair was not associated with reduced mortality, while costs actually increased . Zemlyak et al found no regionalization for non‐trauma related splenectomy so no basis can be claimed for a benefit in doing so.…”

Section: The Era Of Big Data Beginsmentioning

confidence: 99%

Volume‐outcome disparities and informed consent: What should surgeons disclose?

Stell

2014

Journal of Surgical Oncology

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It has been repeatedly shown that higher procedure volumes, by hospital and by physician, are associated with better outcomes. Buttressed by large-scale selective service purchasing, surgical care for many volume-sensitive operations has been regionalized. However, the implications of outcome disparity data for obtaining valid patient consent remain uncertain. When the first large scale outcome study appeared showing empirically that outcomes are volume-related, two prominent bioethicists promptly insisted that such information was material to a reasonable patient's decision whether and where to have a volume-sensitive operation and that surgeons at low-volume hospitals should disclose it. More recently, two surgical oncologists have reiterated that argument, most especially when patients are making decisions about pancreatic or esophageal resections. This proposal tantalizingly appeals to the concept of patient empowerment, supposedly showing appropriate respect for the patient's interest in self-determination by having his surgeon (or physician), rather than others, outline for him personally the risks and benefits associated with surgical care delivered at different hospitals. But on the contrary, a surgeon's conducting a truthful, non-misleading, non-confusing informed consent discussion of statistical outcome disparities in the relentlessly shrinking time typically allowed for this conversation is unrealistic as a general requirement. The traditional approach to informed consent is simpler, less fraught and preferable. By law, a surgeon who is licensed to practice independently and who evidences willingness to examine and to offer an operation to a patient conveys (1) an implicit standard of care assurance, and (2) a fiduciary assurance. In other words, it goes without saying that the surgeon holds it out to the patient that s/he possesses the training and skill necessary to perform the offered service with reasonable skill and safety as measured by the applicable standard of care; that s/he will act in good faith and use his/her best medical judgment on the patient's behalf. Liability attaches when patient harm results from a surgeon's failure on either count. It also goes without saying that the surgeon extends similar assurances for care provided by trainees who are under his or her direct supervisory authority and control. The traditional theory of informed consent forestalls requiring desultory discussions of volume-outcome disparities and will be defended here.

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