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.
| 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.