Splenic Cyst Surgical Treatment: Cyst Resection vs. Partial Splenectomy

Raymundo C Racela, MD, Carl Tadaki, MD, Eugene Boilesen, Valerie Shostrom, Dmitry Oleynikov, MD, Vishal Kothari, MD. U. of Nebraska Medical Center

INTRODUCTION: Splenic cysts are rare but when diagnosed surgery is the primary treatment modality. The purpose of this study is to compare patient outcomes that underwent cyst resection to those that underwent partial splenectomy.

METHODS AND PROCEDURES: The University Health System Consortium (UHC), an alliance of more than 300 academic and affiliated hospitals, was used to identify patients by International Classification of Disease 9th revision Clinical Modification codes (ICD-9CM) from October 2008 to September 2013. Codes for simple splenic cysts (SC) were used to identify the patients. These patients were then broken up into two groups: cystectomy (CF) and partial splenectomy (PS).

RESULTS: 104 patients were identified to have a SC. 34 patients underwent CF and 70 underwent PS. There was no difference in race (p=0.6), sex (p=0.45), age (23 vs. 19; p=0.40), severity of illness score (minor/moderate) (p=0.55), readmissions (p=0.99), total charges (p=0.49), post-operative bleeding or length of stay (p=0.54). The patients undergoing CF were found to have a lower ICU admission rate (0% vs. 13.2%, p=0.0274) and lower direct costs ($5558 vs. $6649, p=0.034). There was no statistical difference in readmission rate or post-operative complications: stroke, aspiration pneumonia, MI, wound infection or sepsis.

Variable Cyst resection N=34 Partial splenectomy N=70 p-value

Race

-Caucasian

-African-American

-Asian

-Other/unknown

25 (73.5%)

2 (5.9%)

0 (0%)

7 (20.6%)

50 (71.4%)

8 (11.4%)

2 (2.9%)

10 (14.3%)

0.5976

Sex

-Male

-Female

11 (32.4%)

23 (67.6%)

28 (40%)

42 (60%)

0.4499

SOI

-1/2

-3/4

34 (100%)

0 (0%)

67 (95.7%)

3 (4.3%)

0.5491
ICU (yes) 0 (0%) 9 (13.2%) 0.0274
Readmit (yes) 1 (2.9%) 4 (5.7%) 0.9999
Age (years) 23 (15.5, 37.5) 19.1 (15.3, 31.7) 0.4037
Total charges 29202 (18949, 40061) 32616 (20037, 110944) 0.4988
Total direct cost 5558 (4284, 7116) 6649 (5339, 11071) 0.0340
Post-operative bleeding 0 (0%) 0 (0%) 0.0
LOS 2 (1,3) 2 (2,4) 0.5449

CONCLUSIONS: Simple splenic cysts are a rare occurrence. Though there are multiple ways to treat this pathology, when attempting a splenic salvage operation a cystectomy is preferred to a partial splenectomy due to the lower ICU admission rate and lower direct cost, with no difference in post-operative complications.

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