Does Laparoscopy Reduce the Need for Incidental Splenic Procedures During Colorectal Resections? an Assessment From the Nsqip Database

Ozgen Isik, MD, Erman Aytac, MD, Jean Ashburn, MD, Gokhan Ozuner, MD, Feza Remzi, MD, Meagan Costedio, MD, Emre Gorgun, MD. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic.

 

Table: Patient characteristics and postoperative outcomes
Variable  Overall Non-splenic procedure Splenic procedure p- value
Age  61.77 +/- 15.59 61.75 +/- 15.59 71.16 +/- 12.93 <0.001
Sex
 
female 28367 (50.7%) 28321 (50.8%) 46 (41.4%) 0.051
 
male 27543 (49.3%) 27478 (49.2%) 65 (58.6%)
BMI  28.01 +/- 6.64 28.02 +/- 6.64 26.92 +/- 5.76 0.18
Open/ Laparoscopy
 
Laparoscopy 22677 (40.6%) 22673 (40.6%) 4 (3.6%) <0.001
 
Open 33233 (59.4%) 33126 (59.4%) 107 (96.4%)
Unplanned intubation  1555 (2.8%) 1545 (2.8%) 10 (9.0%) <0.001
Prolonged (>48h) ventilator dependency  2668 (4.8%) 2640 (4.7%) 28 (25.2%) <0.001
Acute renal failure  526 (0.94%) 522 (0.94%) 4 (3.6%) 0.007
Sepsis  2359 (4.2%) 2345 (4.2%) 14 (12.6%) <0.001
Septic shock  1530 (2.7%) 1519 (2.7%) 11 (9.9%) <0.001
Reoperation requirement  3506 (6.3%) 3489 (6.3%) 17 (15.3%) <0.001
Mortality  1924 (3.4%) 1912 (3.4%) 12 (10.8%) <0.001

Introduction: Nearly half of all incidental splenectomies due to iatrogenic splenic injuries are performed during colorectal surgery. This study evaluates factors associated with incidental splenic procedures during colorectal surgery and their impact on short-term outcomes by using a nationwide database.

Methods and Procedures: Patients who underwent colorectal resections between 2007 and 2010 were identified from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database according to Current Procedural Terminology (CPT) codes. Patients were classified into two groups, based on whether or not they underwent a concurrent splenic procedure. Splenectomies intentionally performed in conjunction with colon or rectal resections, and ileocolic resections were excluded. Perioperative and short-term (30 day) outcomes were compared between the groups.

Results: In total, 55910 patients who underwent colon and/or rectal resection were identified. Among these, 111 patients had incidental splenic procedures (92 splenectomy, 13 splenorraphy, 6 partial splenectomy). Laparoscopic colorectal resections were associated with a significantly lower rate of incidental splenic procedure (0.018% vs. 0.32%, p<0.001) compared to open surgery. Incidental splenic procedures were associated with increased total length of hospital stay (p<0.001), deep incisional surgical site infection (SSI) (p<0.001), organ space SSI (p=0.006), pneumonia (p=0.004), transfusion requirement (p<0.001), and mortality (p<0.001). Short-term advantages of splenic salvage (splenorraphy or partial splenectomy) included shorter length of total hospital stay (p=0.01) and decreased need for re-operation (p=0.041).

Conclusions: Incidental splenic procedures during colorectal resections are associated with increased postoperative morbidity and mortality. Use of the laparoscopic technique is associated with less frequent incidental splenic procedures during colorectal resections.
 

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