True Benefit Or Selection Bias. an Analysis of Laparoscopic Versus Open Splenectomy From the Acs-nsqip

C Gonczy, MD, V Advani, MD, S Markwell, MA, S Ahad, MD, I Hassan, MD. Southern Illinois University School of Medicine


Introduction: By virtue of the benefits associated with minimally invasive approaches, laparoscopic splenectomy (LS) is believed to have better patient-related outcomes compared to open splenectomy (OS). However there is limited data directly comparing the two techniques. 
 Methods: Patients undergoing elective LS and OS between 2005-2009, were identified from the public use file of the ACS-NSQIP database using the Current Procedural Terminology codes 38120 and 38100. Patients undergoing concomitant procedures were excluded. Because of the non-random assignment of surgical techniques a selection bias could have been responsible for the differences in patient outcomes. Therefore patient characteristics and co- morbidities that were available and could have been potential confounders were compared and regression analysis was performed to determine independent risk factors associated with serious and overall morbidity as well as mortality.
 Results: During the study period 1304 and 693 patients underwent LS and OS respectively. Compared to patients undergoing LS, patients whom had OS had a longer mean length of stay (5 vs. 10 days, P<0.0001) higher incidence of serious (6% vs. 12%, P<0.0001) and overall morbidity (11% vs. 20%, P<0.0001) and mortality (2% vs. 3%, P=0.02). However there were certain significant differences in the characteristics and co-morbidities of the patients that could have confounded outcomes (Table) On regression analysis, OS was not associated with higher mortality (OR 1.43, 95% CI 0.7-2.7, P=0.28) but higher serious morbidity (OR 1.8, 95% CI 1.4-2.3, P=0.001) and overall morbidity (OR 2.0, 95% CI 1.6-2.4, P=0.0001).
 Conclusion: After adjusting for available confounders’ patients undergoing LS had lower morbidity and similar mortality. Although certain confounders such as previous surgical history and underlying pathology could still have potentially influenced outcomes the data suggests that when technically possible a minimally invasive technique should be the preferred approach for splenectomy.

Patient Characteristics And Demographics
  LS OS P-value
Age 51 57 0.0001
Male Gender 42% 50% 0.0005
BMI 29 27 0.0001
Steroid use 44% 19% 0.0001
Current smoker 16% 21% 0.007
Bleeding disorder 44% 35% 0.0001
OR time (median, in min.) 120 104 0.0001
Diabetes 13% 13% 0.72
Independent functional status 97% 97% 0.3
Severe COPD 3% 5% 0.07
Coronary Artery Disease 12% 12% 0.86


Session Number: SS07 – Solid Organ
Program Number: S047

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