Julietta Chang, MD1, Amin Andalib, MD2, Zhamak Khorgami, MD3, Stacy Brethauer, MD1, Philip Schauer, MD1, Ali Aminian, MD1. 1Cleveland Clinic Foundation, 2McGill University, 3University of Oklahoma
INTRODUCTION: Splenic injury during laparoscopic surgery is rare and occurs with a reported frequency of 0-2.6% and rarely requires splenectomy, which is usually due to uncontrollable hemorrhage. Iatrogenic splenectomy during abdominal procedures such as colorectal and abdominal vascular surgeries have been associated with increased risk of postoperative infectious complications and prolonged hospitalization. We propose that iatrogenic splenectomy at time of primary bariatric surgery is associated with increased postoperative complications.
METHODS AND PROCEDURES: Data were retrieved from the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) dataset (2005-2014). Inclusion criteria included: adult patients aged ≥18 years and underwent elective primary bariatric surgical procedures including Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), sleeve gastrectomy (SG), and duodenal switch (DS) who underwent unplanned splenectomy at time of their initial procedure. Postoperative composite adverse outcome was defined as presence of any of 16 major adverse events. In order to compare postoperative outcomes, this cohort was compared with patients deemed very high risk which was defined as ASA≥3 + BMI ≥50 + Age ≥50 (n=669).
RESULTS: We identified 25 patients (SG n=15, DS n=5, RYGB n=4, and AGB n=1) including 4 men and 21 women from the 2005-2014 ACS-NSQIP dataset who underwent an unplanned splenectomy during their primary bariatric procedure and 669 patients who were defined as very high risk preoperatively (ASA≥3 + BMI ≥50 + Age ≥50) who did not undergo concomitant splenectomy. Median age in the splenectomy group was 47 (range 25-70); median BMI and ASA class were 48 (range 39-91) kg/m2 and 3 (1-3), respectively. Baseline characteristics revealed that the high-risk comparator group to be significantly older with higher BMI and had a higher incidence of preoperative comorbid conditions including diabetes, hypertension, and preoperative dyspnea compared to the simultaneous splenectomy group.
With regards to postoperative outcomes, there was a trend towards more adverse events in the simultaneous splenectomy group compared to the high risk group (20% compared to 9%, P = 0.07); however, there were significantly more thromboembolic complications (12% versus 1%, P < 0.001), as well as a significantly higher incidence of unplanned readmissions (32% vs 8%, P < 0.001).
CONCLUSION: Iatrogenic splenectomy at time of primary bariatric procedure is associated with increased risk of thromboembolic complications and a higher rate of readmission at 30 days postoperatively even in comparison to a group of patients who carry a higher preoperative risk.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79374
Program Number: P515
Presentation Session: Poster (Non CME)
Presentation Type: Poster