Riley D Stewart, MD, Jon Bailey, MD, Dennis R Klassen, MD. Dalhousie University
INTRODUCTION: Though many open splenectomies are still performed4, most consider laparoscopic splenectomy the standard3. Patient age, co-morbidities and the presence of splenomegaly may influence the operative approach. Our group has previously reported on the safety of laparoscopic and hand-assisted splenectomy in the elderly with splenomegaly.1,2 Few studies have compared outcomes between older and younger adults in laparoscopic splenectomy.5
Thus, we retrospectively reviewed our experience in laparoscopic splenectomy comparing outcomes between younger (<65) and older (≥65) adults. We hypothesized older adults would experience higher complication rates and length of stay.
METHODS: Elective laparoscopic and hand-assisted splenectomies performed between 2003 – 2012 at our institution were retrospectively reviewed. Patients were excluded if splenectomy was not performed alone or if splenulectomy only was performed. Patients were stratified into younger (<65) and older (≥65) adults. Patient characteristics (age, gender, BMI, Charlson comorbidity index, ASA), operative characteristics (OR time, approach, blood loss, spleen weight, and spleen interpole length) and post-operative characteristics (length of stay, Clavian-Dindo score, and re-operation or death within 30 days) were compared between groups.
Continuous variables were analyzed using student t-test and categorical variable by Chi-squared test. P <0.05 was considered significant.
RESULTS: One hundred forty-six splenectomies were performed. The average age in each group was significantly different (45.4 vs 74.8 years). There were no differences in gender distribution between groups. Older patients had significantly lower BMI’s (27 vs 30); potentially due to chronic disease. Older patients were more co-morbid; evidenced by significant differences in ASA, Charlson comorbidity index, and frequency of hematologic malignancy. (2 vs 3, 2 vs 5, 23.4 vs 46.4%)
Operative times, blood loss, and frequency of accessory spleens were not different between groups. (128 vs 141 min, 154 vs 159 ml, 9.2 vs 15.9%) Older patients were significantly more likely to need a hand-assisted approach (39.1 vs 19.5%) due to the significant difference in weight and interpole spleen length. (555 vs 1025 g, 13.8 vs 16.4 cm)
There were no differences in length of stay and re-operation or death within 30 days. (4.3 vs 6.9, 1 vs 4, 0 vs 1) There were significantly more complications in the older group. This difference is almost entirely represented by grade 1 and 2 Clavian-Dindo complications.
CONCLUSION: Despite differences in co-morbidities and the technical challenges with massive splenomegaly in older adults, perioperative complications were only modestly increased. Laparoscopic splenectomy should be the preferred operative approach in most elective splenectomies.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79519
Program Number: P700
Presentation Session: Poster (Non CME)
Presentation Type: Poster
