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Tang-Tan A, Chien CY, Park S, Schellenberg M, Lam L, Martin M, Inaba K, Matsushima K. Clinical factors and outcomes of spleen-conserving surgery versus total splenectomy in splenic injuries: A nationwide database study. Am J Surg 2024; 233:142-147. [PMID: 38490878 DOI: 10.1016/j.amjsurg.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The objective of this study was to identify factors associated with the use of spleen-conserving surgeries, as well as patient outcomes, on a national scale. METHODS This retrospective cohort study (2010-2015) included patients (age≥16 years) with splenic injury in the National Trauma Data Bank. Patients who received a total splenectomy or a spleen-conserving surgery were compared for demographics and clinical outcomes. RESULTS During the study period, 18,425 received a total splenectomy and 1,825 received a spleen-conserving surgery. Total splenectomy was more likely to be performed for patients with age>65 (odds ratio [OR]: 0.63, p < 0.001), systolic blood pressure<90 (OR: 0.63, p < 0.001), heart rate>120 (OR: 0.83, p = 0.007), and high-grade injuries (OR: 0.18, p < 0.001). Penetrating trauma patients were more likely to undergo a spleen-conserving surgery (OR: 3.31, p < 0.001). The use of spleen-conserving surgery was associated with a lower risk of pneumonia (OR: 0.79, p = 0.009) and venous thromboembolism (OR: 0.72, p = 0.006). CONCLUSIONS Spleen-conserving surgeries may be considered for patients with penetrating trauma, age<65, hemodynamic stability, and low-grade injuries. Spleen-conserving surgeries have decreased risk of pneumonia and venous thromboembolism.
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Affiliation(s)
- Angela Tang-Tan
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Chih Ying Chien
- Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd, Anle District, Keelung City, 204, Taiwan.
| | - Stephen Park
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Morgan Schellenberg
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Lydia Lam
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Matthew Martin
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Kenji Inaba
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
| | - Kazuhide Matsushima
- Department of Surgery, University of Southern California, 2051 Marengo St. Los Angeles, 90033, CA, USA.
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Dong W, Chu HB. Role of splenomegaly in surgical treatment of portal hypertension. WORLD CHINESE JOURNAL OF DIGESTOLOGY 2024; 32:248-253. [DOI: 10.11569/wcjd.v32.i4.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
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Adams-McGavin RC, Tafur M, Vlachou PA, Wu M, Brassil M, Crivellaro P, Lin HM, Gomez D, Colak E. Interrater Agreement of CT Grading of Blunt Splenic Injuries: Does the AAST Grading Need to Be Reimagined? Can Assoc Radiol J 2024; 75:171-177. [PMID: 37405424 DOI: 10.1177/08465371231184425] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Introduction: The Revised Organ Injury Scale (OIS) of the American Association for Surgery of Trauma (AAST) is the most widely accepted classification of splenic trauma. The objective of this study was to evaluate inter-rater agreement for CT grading of blunt splenic injuries. Methods: CT scans in adult patients with splenic injuries at a level 1 trauma centre were independently graded by 5 fellowship trained abdominal radiologists using the AAST OIS for splenic injuries - 2018 revision. The inter-rater agreement for AAST CT injury score, as well as low-grade (IIII) versus high-grade (IV-V) splenic injury was assessed. Disagreement in two key clinical scenarios (no injury versus injury, and high versus low grade) were qualitatively reviewed to identify possible sources of disagreement. Results: A total of 610 examinations were included. The inter-rater absolute agreement was low (Fleiss kappa statistic 0.38, P < 0.001), but improved when comparing agreement between low and high grade injuries (Fleiss kappa statistic of 0.77, P < .001). There were 34 cases (5.6%) of minimum two-rater disagreement about no injury vs injury (AAST grade ≥ I). There were 46 cases (7.5%) of minimum two-rater disagreement of low grade (AAST grade I-III) versus high grade (AAST grade IV-V) injuries. Likely sources of disagreement were interpretation of clefts versus lacerations, peri-splenic fluid versus subcapsular hematoma, application of adding multiple low grade injuries to higher grade injuries, and identification of subtle vascular injuries. Conclusion: There is low absolute agreement in grading of splenic injuries using the existing AAST OIS for splenic injuries.
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Affiliation(s)
- R Chris Adams-McGavin
- Department of Surgery, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monica Tafur
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paraskevi A Vlachou
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Wu
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael Brassil
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Priscila Crivellaro
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hui-Ming Lin
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - David Gomez
- Department of Surgery, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Division of General Surgery, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Errol Colak
- Department of Medical Imaging, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
- Department of Medical Imaging, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
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Schunn MC, Schäfer J, Neunhoeffer F, Lieber J, Fuchs J. [Blunt abdominal trauma in children and adolescents: treatment concepts in the acute phase]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:651-663. [PMID: 37338573 DOI: 10.1007/s00104-022-01798-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 06/21/2023]
Abstract
Fatal accidents due to blunt force trauma are the leading cause of death in children and adolescents [1]. Abdominal trauma is the third most common cause of death after traumatic brain injury and thoracic injuries [2]. Abdominal injury is seen in approximately 2-5% of children involved in accidents [3]. Blunt abdominal injuries are common sequelae of traffic accidents (for example as seat belt injury), falls, and sports accidents. Penetrating abdominal injuries are rare in central Europe. Spleen, liver, and kidney lacerations are the most common injuries after blunt abdominal trauma [4]. In most situations, nonoperative management (NOM) has become the gold standard with the surgeon leading the multidisciplinary treatment [5].
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Affiliation(s)
- M C Schunn
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - J Schäfer
- Diagnostische und Interventionelle Radiologie, Abteilung für Kinderradiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - F Neunhoeffer
- Klinik für Kinderheilkunde, Abteilung für Kinderkardiologie, Intensivmedizin und Pulmonologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Lieber
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - J Fuchs
- Klinik für Kinder- und Jugendmedizin, Abteilung für Kinderchirurgie und Kinderurologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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Segalini E, Khan M, Podda M, Gallo G, Morello A, Marziali I, DI Saverio S. The role of laparoscopic splenectomy in traumatic splenic injury: a narrative review. Minerva Surg 2023; 78:76-80. [PMID: 36448883 DOI: 10.23736/s2724-5691.22.09799-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Splenic injuries are one of the commonest occurrences in abdominal trauma. Nonoperative management (NOM) is the treatment of choice in hemodynamically stable patients with low grade injuries in the absence of vascular injury on CT; however, in some cases, NOM can fail and surgery is required. Traditionally, splenectomy is performed via laparotomy but, recently, the use of laparoscopy is rapidly increasing because the numerous advantages it offers for selected trauma patients. EVIDENCE ACQUISITION A systematic review of the literature was performed through Medline for papers on the laparoscopic splenectomy (LS) in trauma patients, published from January 2006 to July 2022. The inclusion criteria were the study population consisted of hemodynamically stable adult patients treated with LS, as primary treatment or in case of complication or failure of NOM. The data extracted included gender, patient age, type of trauma, ISS, indication for LS and if LS was performed primary or secondary to NOM. The considered outcomes were operative time, length of stay, morbidity and mortality. EVIDENCE SYNTHESIS Eight papers were considered suitable for the study and all the articles were retrospective studies and only one of them was multicentered. A total of 202 patients were included in the study and all of these suffered splenic trauma and all patients were hemodynamically stable or responding to fluid resuscitation. Trauma mechanism was blunt in 92.9% of cases and penetrating in 7%. Twenty-one patients underwent LS after failure of angioembolization. Operative time of LS was reported in 6 papers and the mean was 130.7 mins. Length of stay was reported in 7 papers and the mean was 8.12 days. Overall morbidity was 7.7% and the postoperative mortality was cited in 6 articles with an overall percentage of 2.5%. CONCLUSIONS Laparoscopy should be considered a valid alternative to open surgery, in hemodynamically stable patients and when performed by an experienced surgeon, such as the minimally invasive trauma surgeon.
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Affiliation(s)
- Edoardo Segalini
- Department of General and Emergency Surgery, ASST Ospedale Maggiore, Crema, Cremona, Italy
| | | | - Mauro Podda
- Emergency Surgery Unit, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gaetano Gallo
- Department of Medical and Surgical Science, University of Catanzaro, Catanzaro, Italy
| | - Alessia Morello
- Department of Emergency, ASST Ospedale Maggiore, Crema, Cremona, Italy
| | - Irene Marziali
- Department of General Surgery, Madonna del Soccorso Civil Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy
| | - Salomone DI Saverio
- Department of General Surgery, Madonna del Soccorso Civil Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy -
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Pancreatic Fistula and Biochemical Leak after Splenectomy: Incidence and Risk Factors-A Retrospective Single-Center Analysis. Langenbecks Arch Surg 2022; 407:2517-2525. [PMID: 35508768 PMCID: PMC9468060 DOI: 10.1007/s00423-022-02531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 04/21/2022] [Indexed: 11/24/2022]
Abstract
Purpose Postoperative pancreatic fistula (POPF) is a complication discussed in the context of pancreatic surgery, but may also result from splenectomy; a relationship that has not been investigated extensively yet. Methods This retrospective single-center study aimed to analyze incidence of and risk factors for POPF after splenectomy. Patient characteristics included demographic data, surgical procedure, and intra- and postoperative complications. POPF was defined according to the International Study Group on Pancreatic Surgery as POPF of grade B and C or biochemical leak (BL). Results Over ten years, 247 patients were identified, of whom 163 underwent primary (spleen-associated pathologies) and 84 secondary (extrasplenic oncological or technical reasons) splenectomy. Thirty-six patients (14.6%) developed POPF of grade B/C or BL, of which 13 occurred after primary (7.9%) and 23 after secondary splenectomy (27.3%). Of these, 25 (69.4%) were BL, 7 (19.4%) POPF of grade B and 4 (11.1%) POPF of grade C. BL were treated conservatively while three patients with POPF of grade B required interventional procedures and 4 with POPF of grade C required surgery. POPF and BL was noted significantly more often after secondary splenectomy and longer procedures. Multivariate analysis confirmed secondary splenectomy and use of energy-based devices as independent risk factors for development of POPF/BL after splenectomy. Conclusion With an incidence of 4.5%, POPF is a relevant complication after splenectomy. The main risk factor identified was secondary splenectomy. Although POPF and BL can usually be treated conservatively, it should be emphasized when obtaining patients’ informed consent and treated at centers with experience in pancreatic surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02531-7.
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Lin CC, Hsu SD, Chien WC, Chung CH, Chen CJ, Liang CM, Hong ZJ. Comparison of Long-Term Pneumonia Risk between Spleen Injury and Non-Spleen Injury after Total Splenectomy—A Population-Based Study. J Pers Med 2022; 12:jpm12020308. [PMID: 35207798 PMCID: PMC8877515 DOI: 10.3390/jpm12020308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Patients who undergo splenectomy are at a high risk of infection. We aimed to investigate the rate of pneumonia in patients who underwent splenectomy, specifically comparing those who had splenectomy due to spleen injury and those who had it for other reasons. A population-based cohort study was conducted. Overall, 17,498 patients who underwent splenectomy between 2000 and 2015 were enrolled, including 11,817 patients with a history of spleen injury and 5681 controls without spleen injury. The incidence of pneumonia was calculated at the end of 2016. A multivariable Cox proportional hazards regression model was used to compare the hazard ratio with 95% CI for pneumonia associated with the spleen injury-caused splenectomy and splenectomy due to other causes. The crude HR for patients with splenectomy due to spleen injury to develop pneumonia was 1.649. After adjusting for covariates, the adjusted hazard ratio was 1.567. There were statistically significant differences in all subgroups, except for the group with a tracking duration >10 years. We found an increase in pneumonia risk in the ‘spleen injury’ group when comparing it to that of the ‘other causes’ group, regardless of age, sex, and area of residence.
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Affiliation(s)
- Chun-Cheng Lin
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Sheng-Der Hsu
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-J.C.); (C.-M.L.); (Z.-J.H.)
- Correspondence:
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Cheng-Jueng Chen
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-J.C.); (C.-M.L.); (Z.-J.H.)
| | - Chia-Ming Liang
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-J.C.); (C.-M.L.); (Z.-J.H.)
| | - Zhi-Jie Hong
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan; (C.-J.C.); (C.-M.L.); (Z.-J.H.)
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Paltiel HJ, Barth RA, Bruno C, Chen AE, Deganello A, Harkanyi Z, Henry MK, Ključevšek D, Back SJ. Contrast-enhanced ultrasound of blunt abdominal trauma in children. Pediatr Radiol 2021; 51:2253-2269. [PMID: 33978795 DOI: 10.1007/s00247-020-04869-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/26/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022]
Abstract
Trauma is the leading cause of morbidity and mortality in children, and rapid identification of organ injury is essential for successful treatment. Contrast-enhanced ultrasound (CEUS) is an appealing alternative to contrast-enhanced CT in the evaluation of children with blunt abdominal trauma, mainly with respect to the potential reduction of population-level exposure to ionizing radiation. This is particularly important in children, who are more vulnerable to the hazards of ionizing radiation than adults. CEUS is useful in hemodynamically stable children with isolated blunt low- to moderate-energy abdominal trauma to rule out solid organ injuries. It can also be used to further evaluate uncertain contrast-enhanced CT findings, as well as in the follow-up of conservatively managed traumatic injuries. CEUS can be used to detect abnormalities that are not apparent by conventional US, including infarcts, pseudoaneurysms and active bleeding. In this article we present the current experience from the use of CEUS for the evaluation of pediatric blunt abdominal trauma, emphasizing the examination technique and interpretation of major abnormalities associated with injuries in the liver, spleen, kidneys, adrenal glands, pancreas and testes. We also discuss the limitations of the technique and offer a review of the major literature on this topic in children, including an extrapolation of experience from adults.
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Affiliation(s)
- Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Richard A Barth
- Department of Radiology, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Stanford, CA, USA
| | - Costanza Bruno
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Aaron E Chen
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Zoltan Harkanyi
- Department of Radiology, Heim Pal National Pediatric Institute, Budapest, Hungary
| | - M Katherine Henry
- Safe Place: The Center for Child Protection and Health, Division of General Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ren C, Lu H, Xia H, Zhang J, Cao B, Wang Y, Lu D, Cao R. Alterations of coagulation and fibrinolysis in patients with blunt splenic injury after splenic artery embolization. J Clin Lab Anal 2021; 35:e23801. [PMID: 33955612 PMCID: PMC8183903 DOI: 10.1002/jcla.23801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background Thrombotic complications following splenectomy have been documented. However, there has been sparse literature regarding thrombotic complications following splenic artery embolization (SAE).The objective of this study was to determine changes in coagulation and fibrinolysis and assess the thrombotic risk after SAE in patients with blunt splenic injury (BSI). Methods This study included 38 BSI patients who were hemodynamically stable on admission. SAE was performed if the splenic injury was classed as grade III or greater and had no requirement of immediate surgery. Platelet (PLT), fibrinogen (FIB), D‐dimers (D‐D), fibrinogen/fibrin degradation products (FDP), antithrombin III (AT III), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), hemoglobin (Hb), and hematocrit (Hct) were measured before SAE procedures and then 1d, 3d, and 7d after SAE. Results The technical success rate of SAE and the splenic salvage rate were 100%. There was no mortality. Compared with pre‐SAE values, the levels of PLT, FIB, D‐D, and FDP increased significantly at 3 days and 7 days after SAE (p < 0.05). However, AT III, PT, APTT, TT, Hb, and Hct showed no statistically significant difference at 1d, 3d, and 7d after SAE (p > 0.05). Conclusion Alterations in PLT and hemostatic parameters might contribute to the increased risk of thrombotic complications in BSI patients undergoing SAE. Thromboembolism following SAE should be considered and thrombotic prophylaxis should be recommended.
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Affiliation(s)
- Chuanzeng Ren
- Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Huadong Lu
- Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Honghai Xia
- Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jia Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Bin Cao
- Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Ying Wang
- Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Dong Lu
- Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Rongge Cao
- Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Latz CA, Lella S, Boitano LT, DeCarlo C, Feldman Z, Png CYM, Mohebali J, Dua A, Conrad M. Short- and long-term outcomes after concurrent splenectomy during thoracoabdominal aortic aneurysm repair. J Vasc Surg 2021; 74:1109-1116. [PMID: 33887425 DOI: 10.1016/j.jvs.2021.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Splenectomy is often performed during open thoracoabdominal aortic aneurysm (TAAA) repair, because capsular tears are common and can be associated with significant bleeding. It is unknown whether splenectomy affects the short- or long-term outcomes after TAAA repair. METHODS All open type I to IV TAAA repairs performed from 1987 to June 2015 were evaluated using a single institutional database. The primary endpoints were in-hospital death, major adverse events (MAE) and long-term survival. The secondary endpoint was hospital length of stay (LOS). All repairs performed for aneurysm rupture were excluded. Univariate analysis was conducted using the Fisher's exact test for categorical variables and the Wilcoxon rank sum test for continuous variables. Logistic and linear multivariable regression were used for the in-hospital endpoints, and survival analyses were performed using Cox proportional hazards modeling and Kaplan-Meier techniques. RESULTS A total of 649 patients met the study inclusion criteria. Of the 649 patients, 150 (23%) underwent concurrent splenectomy (CS) and six required emergency splenectomy secondary to bleeding postoperatively, leading to 156 cases of total in-hospital splenectomy. The perioperative mortality rate was 5.2% in the CS group and 5.2% in the non-CS group (P = 1.0). MAE were experienced by 48% of the CS patients compared with 34% of the non-CS patients (P = .003). Multivariable analysis revealed splenectomy was not independently predictive of perioperative death (adjusted odds ratio, 0.95; 95% confidence interval [CI], 0.41-2.23; P = .9). However, splenectomy was independently associated with any MAE (adjusted odds ratio, 1.78; 95% CI, 1.19-2.65; P = .005). Splenectomy was also associated with a longer length of stay (+5.39 days; 95% CI, 1.86-8.92; P = .003). No survival difference was found between the cohorts in the total splenectomy cohort in the unadjusted (log-rank P = 1.0) or adjusted (splenectomy adjusted hazard ratio, 1.02; 95% confidence interval, 0.78-1.35; P = .9). CONCLUSIONS CS during open TAAA repair did not lead to increased perioperative mortality but did lead to significantly increased perioperative morbidity and longer hospital lengths of stay. We found no difference in long-term survival outcomes when CS was performed. Splenectomy during TAAA repair did not affect long-term survival.
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Affiliation(s)
- Christopher A Latz
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass.
| | - Srihari Lella
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Laura T Boitano
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Charles DeCarlo
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Zach Feldman
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - C Y Maximilian Png
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Jahan Mohebali
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark Conrad
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
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Fransvea P, Costa G, Serao A, Cortese F, Balducci G, Sganga G, Marini P. Laparoscopic splenectomy after trauma: Who, when and how. A systematic review. J Minim Access Surg 2021; 17:141-146. [PMID: 31670290 PMCID: PMC8083752 DOI: 10.4103/jmas.jmas_149_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Importance: A deep knowledge of the indication for laparoscopic splenectomy (LS) in trauma case can lead trauma surgeon to offer in a wider number of situations a minimally invasive approach to a common injuries. Objective: To present and review the advantages and disadvantages of laparoscopic approach for spleen trauma and to identify patient whose can benefit from a minimally invasive approach versus patient that need open surgery to assess the whole severity of trauma. Evidence Review: A systematic review was performed according to the PRISMA statement in order to identify articles reporting LS after trauma. A literature search was performed through MEDLINE (through PubMed), Embase and Google Scholar from January 1990 to December 2018. Studies conducted on animals were not considered. All other laparoscopic procedures for spleen trauma were excluded. Results: Nineteen articles were included in this study, reporting 212 LS after trauma. The most study includes blunt trauma patient. All LS were performed in haemodynamically stable patient. Post-operative complications were reported in all articles with a median post-operative morbidity rate of 30 patients (14.01%), including 16 (7.5%) post-operative deaths. Conclusions and Relevance: This article reports the feasibility and safety of a minimally invasive approach for common trauma injuries which can help non-advanced laparoscopic skill trauma surgeon to develop the best indication to when to adopt this kind of approach.
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Affiliation(s)
- Pietro Fransvea
- Division of Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, Rome, Italy
| | - Gianluca Costa
- Department of Translational Medicine, Sant' Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Angelo Serao
- Department of General Surgery, Ospedale Dei Castelli, Ariccia, Rome, Italy
| | - Francesco Cortese
- Emergency Surgery and Trauma Care Unit, St Filippo Neri Hospital, Rome, Italy
| | - Genoveffa Balducci
- Department of Translational Medicine, Sant' Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of Rome, Rome, Italy
| | - Pierluigi Marini
- Department of General and Emergency Surgery, St. Camillo Forlanini's Hospital, Rome, Italy
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Filippova OT, Kim SW, Cowan RA, Chi AJ, Iasonos A, Zhou QC, Broach V, Zivanovic O, Long Roche K, Sonoda Y, Gardner G, Chi DS. Hematologic changes after splenectomy for ovarian cancer debulking surgery, and association with infection and venous thromboembolism. Int J Gynecol Cancer 2020; 30:1183-1188. [PMID: 32665236 DOI: 10.1136/ijgc-2020-001368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The spleen plays a role in the immune and coagulative responses, yet a splenectomy may be required during ovarian cancer surgery to achieve complete cytoreduction. The aim of the study was to correlate hematologic changes with the development of infection and venous thromboembolism in patients undergoing splenectomy. METHODS This single-institution retrospective review includes all patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer, March 2001 to December 2016. We compared postoperative hematologic changes (evaluated daily before discharge) in patients developing infection within 30 days' post-surgery (Infection group) with those who did not (No-Infection group). We also compared patients developing venous thromboembolism with those without. RESULTS A total of 265 patients underwent splenectomy. Median age was 64 years (range 22-88): 146 (55%) patients had stage IIIC and 114 (43%) patients had stage IV. The majority, 201 (76%) patients underwent splenectomy during primary debulking. A total of 132 (50%) patients comprised the Infection group (most common: urinary tract infection, 54%). Median time from surgery to infection was 8 days (range, 0-29). After initial rise in white blood cell count in both groups, the Infection group had a second peak on postoperative day 10 (median 16.6K/mcL, IQR 12.5-21.2) not seen in the No-Infection group (median 12K/mcL, IQR 9.3-16.3). A total of 40 (15%) patients developed venous thromboembolism, median time of 6.5 days (range, 1-43). All patients demonstrated a continuous rise in platelets during postoperative days 0-15. Thrombocytosis was present in 38/40 (95%) patients with venous thromboembolism vs 183/225 (81%) patients without (P=0.036). Median days with thrombocytosis was higher in venous thromboembolism (8 days, range 1-15) vs non groups (6 days, range 1-16, P=0.049). CONCLUSION We identified initial leukocytosis after splenectomy in all patients. The Infection group had a second peak in white blood cell count on postoperative day 10, not present in the No-Infection group. Among patients with venous thromboembolism, thrombocytosis was more frequent and of longer duration.
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Affiliation(s)
- Olga T Filippova
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sun Woo Kim
- University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Renee A Cowan
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vance Broach
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara Long Roche
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dennis S Chi
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Senekjian L, Cuschieri J, Robinson BRH. Splenic artery angioembolization for high-grade splenic injury: Are we wasting money? Am J Surg 2020; 221:204-210. [PMID: 32693942 DOI: 10.1016/j.amjsurg.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Non-operative management (NOM) is accepted treatment of splenic injury, but this may fail leading to splenectomy. Splenic artery embolization (SAE) may improve rate of salvage. The purpose is to determine the cost-utility of the addition of SAE for high-grade splenic injuries. METHODS A cost-utility analysis was developed to compared NOM to SAE in patients with blunt splenic injury. Sensitivity analysis was completed to account for uncertainty. Utility outcome was quality-adjusted life years (QALY). RESULTS For patients with grade III, IV and V injury NOM is the dominant strategy. The probability of NOM being the more cost-effective strategy is 87.5% in patients with grade V splenic injury. SAE is not the favored strategy unless the probability of failure of NOM is greater than 70.0%. CONCLUSION For grade III-V injuries, NOM without SAE yields more quality-adjusted life years. NOM without SAE is the most cost-effective strategy for high-grade splenic injuries.
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Affiliation(s)
- Lara Senekjian
- Division of Trauma and Burns, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359796, Seattle, WA, 98104, USA; Department of Surgery, University of California San Francisco, East Bay - Alameda Health System, 1411 E. 31st Street, Oakland, CA, 94602, USA.
| | - Joseph Cuschieri
- Division of Trauma and Burns, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359796, Seattle, WA, 98104, USA.
| | - Bryce R H Robinson
- Division of Trauma and Burns, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359796, Seattle, WA, 98104, USA.
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Pasteurella bacteraemia: Impact of comorbidities on outcome, based on a case series and literature review. Int J Infect Dis 2020; 92:89-96. [PMID: 31926353 DOI: 10.1016/j.ijid.2020.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Pasteurella bacteraemia is rare, but has been associated with a high mortality rate. The aim of this study was to estimate the impact of comorbidities on patients with Pasteurella bacteraemia. METHODS All cases of Pasteurella bacteraemia in adults treated in our centre between January 2008 and December 2017 were included retrospectively and compared with cases identified in a systematic review of the literature via MEDLINE covering the years 1951-2017. The epidemiological, bacteriological, and clinical data were collected, as well as the instances of death after 30 days. RESULTS Twenty cases of Pasteurella bacteraemia identified in our centre and 99 cases from the literature review were included. A major comorbidity was found in 80/119 (67.2%) patients. The death rate at 30 days was 31.1%. The most common comorbidities were cirrhosis, immunosuppressive therapy, and malignant diseases. Age was not associated with mortality. On multivariate analysis, the only factor associated with mortality was a major comorbidity (odds ratio 2.78, 95% confidence interval 1.01-7.70; p = 0.04). CONCLUSIONS This study confirms the high mortality rate and highlights the importance of the host background, independent of age, in Pasteurella bacteraemia. Clinicians should be aware of the comorbidities in cases of Pasteurella infection, due to the poor prognosis of bacteraemia.
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Mangano A, Gheza F, Giulianotti PC. Iatrogenic spleen injury during minimally invasive left colonic flexure mobilization: the quest for evidence-based results. MINERVA CHIR 2018; 73:512-519. [DOI: 10.23736/s0026-4733.18.07737-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dumas G, Bigé N, Lemiale V, Azoulay E. Patients immunodéprimés, quel pathogène pour quel déficit immunitaire ? (en dehors de l’infection à VIH). MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Le nombre de patients immunodéprimés ne cesse d’augmenter en raison de l’amélioration du pronostic global du cancer et de l’utilisation croissante d’immunosuppresseurs tant en transplantation qu’au cours des maladies auto-immunes. Les infections sévères restent la première cause d’admission en réanimation dans cette population et sont dominées par les atteintes respiratoires. On distingue les déficits primitifs, volontiers révélés dans l’enfance, des déficits secondaires (médicamenteux ou non), les plus fréquents. Dans tous les cas, les sujets sont exposés à des infections inhabituelles de par leur fréquence, leur type et leur sévérité. À côté des pyogènes habituels, les infections opportunistes et la réactivation d’infections latentes font toute la complexité de la démarche diagnostique. Celle-ci doit être rigoureuse, orientée par le type de déficit, les antécédents, les prophylaxies éventuelles et la présentation clinicoradiologique. Elle permettra seule de guider le traitement probabiliste et les examens étiologiques, l’absence de diagnostic étant associée à une mortalité élevée.
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Mangano A, Fernandes E, Valle V, Bustos R, Gheza F, Giulianotti PC. Iatrogenic spleen injury risk during robotic left colonic and rectal resections by routine left flexure mobilization technique: a retrospective study. MINERVA CHIR 2018; 73:451-459. [PMID: 29806761 DOI: 10.23736/s0026-4733.18.07806-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The routine mobilization of the left colonic flexure as a standard procedure during left colonic/rectal resection is a controversial topic in open and minimally invasive surgery. According to some authors, this maneuver may increase the risk of iatrogenic spleen damage; for others this does not change the odds. Ligaments over-traction is the most frequent injury mechanism. Some documented risk factors are reported: laparotomic approach, male gender, vascular disease, cancer, diverticulitis, surgery performed in emergency-setting. The type of procedure influences the associated risk: transverse colectomy is the riskiest, followed by left colonic resection and pancolectomy. METHODS Retrospective original paper. Sample size - a total of 125 patients have been considered. 75 robotic left colonic resections (60%), 40 robotic rectal resections (32%) and 10 robotic pancolectomy (8%). Primary outcomes - 1) percentage of iatrogenic splenic injuries; 2) conversion rate. Secondary outcomes - 1) intra-/postoperative complications; 2) anastomotic leakage rate; 3) mortality. In order to avoid potential confounding factors and technical/expertise heterogeneity, all the procedures included have been performed using the same standardized operative technique and by the same experienced surgeon (P.C.G.). RESULTS We retrospectively analyzed 125 procedures. Primary outcomes - 1) iatrogenic splenic injuries: 0%; 2) conversion rate: 1.6%. Secondary outcomes - 1) intraoperative complications: 0%; 2) anastomotic leakage rate: 1 case of leakage out of 125 cases (1.3% of the left colectomy sub-sample); in this case the leakage was probably due to an infectious process rather than a vascular deficit; 3) mortality: 0%; 4) miscellanea postoperatory complications (small bowel obstructions, wound infection, pelvic collections, pneumonia and acute kidney injury) are detailed in the manuscript. CONCLUSIONS In our experience, and according to some of the literature data as well, during robotic left colonic/rectal resections the routine mobilization of the left flexure as a standard procedure is not a risk factor in terms of iatrogenic spleen injury rate. Conversely, this technique may be beneficial as it does not excessively extend the operative time, increases the surgical skills acquirement, and reduces the tension-related anastomotic ischemia. It also allows a better oncological dissection. Standard laparoscopic approach reduces the rate of spleen by almost 3.5 times in comparison to open surgery. The improved technical accuracy provided by the robotic platform may decrease the rate of splenic injury. More studies are needed on the topic to confirm our findings.
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Affiliation(s)
- Alberto Mangano
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA -
| | - Eduardo Fernandes
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Valentina Valle
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Roberto Bustos
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Federico Gheza
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Pier Cristoforo Giulianotti
- Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois at Chicago, Chicago, IL, USA
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