Institutional members access full text with Ovid®

Postoperative Outcomes After Laparoscopic Splenectomy Compared With Open Splenectomy

Musallam, Khaled M. MD, PhD*,†; Khalife, Mohamed MD; Sfeir, Pierre M. MD; Faraj, Walid MD; Safadi, Bassem MD; Abi Saad, George S. MD; Abiad, Firass MD; Hallal, Ali MD; Alwan, Melhim Bou MD§; Peyvandi, Flora MD, PhD; Jamali, Faek R. MD, FACS

doi: 10.1097/SLA.0b013e318275496a
Original Articles

Objective: To evaluate 30-day postoperative outcomes in laparoscopic (LS) versus open splenectomy (OS).

Summary Background Data: LS has generally been associated with lower rates of postoperative complications than OS. However, evidence mainly comes from small studies that failed to adjust for the confounding effects of the underlying indication or clinical condition that may have favored the use of one technique over the other.

Methods: A retrospective cohort study of patients undergoing splenectomy in 2008 and 2009 using data from the American College of Surgeons National Surgical Quality Improvement Program database (n = 1781). Retrieved data included 30-day mortality and morbidity (cardiac, respiratory, central nervous system, renal, wound, sepsis, venous thromboembolism, and major bleeding outcomes), demographics, indication, and preoperative risk factors. We used multivariate logistic regression to assess the adjusted effect of the splenectomy technique on outcomes.

Results: A total of 874 (49.1%) cases had LS and 907 (50.9%) had OS. After adjusting for all potential confounders including the indication and preoperative risk factors, LS was associated with decreased 30-day mortality [OR (odds ratio): 0.39, 95% CI: 0.18–0.84] and postoperative respiratory occurrences (OR: 0.46, 95% CI: 0.27–0.76), wound occurrences (OR: 0.37, 95% CI: 0.11–0.79), and sepsis (OR: 0.52, 95% CI: 0.26–0.89) when compared with OS. Patients who underwent LS also had a significantly shorter total length of hospital stay and were less likely to receive intraoperative transfusions compared with patients who underwent OS.

Conclusions: LS is associated with more favorable postoperative outcomes than OS, irrespective of the indication for splenectomy or the patient's clinical status.

Using a large cohort of patients from the American College of Surgeons National Surgical Quality Improvement Program database, we demonstrated that laparoscopic splenectomy is associated with a reduction in 30-day postoperative mortality, morbidity (pulmonary, wound, and infectious complications), and total hospital stay compared with open splenectomy, irrespective of the indication for splenectomy or the patient's clinical status.

*Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon

Department of Medicine and Medical Specialties, Angleo Bianchi Bonomi Haemophilia and Thrombosis Center, IRCCS Ca' Granda Foundation Maggiore Policlinico Hospital, Milan, Italy

Department of Surgery, Division of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon

§Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA.

Reprints: Faek R. Jamali, MD, FACS, Department of Surgery, General Surgery Residency, NSQIP Surgeon Champion, American University of Beirut Medical Center, PO Box 11-0236, Beirut 1107 2020, Lebanon. E-mail: fj03@aub.edu.lb.

Disclosure: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and the hospitals participating in the ACS NSQIP provided the data; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. The authors declare no conflicts of interest and no funding.

© 2013 Lippincott Williams & Wilkins, Inc.