Risks of synchronous gastrointestinal or biliary surgery with splenectomy for hematologic disease

Background: The addition of splenectomy to a gastrointestinal (GI) operation may have an adverse effect on mortality, morbidity, and even survival. Objective: To determine the risks of the converse: synchronous GI surgery appended to splenectomy for hematologic diseases. Design: Retrospective cohort. Setting: Multiple hospitals comprising an affiliated surgical training program. Patients: Consecutive sample of 207 adults (mean age, 49 years) with splenectomies for hematologic diseases. Intervention: Splenectomy and concomitant GI or biliary surgery (group 1, n=19) and splenectomy alone (group 2, n=188). Main Outcome Measures: Length of hospital or intensive care unit stay, later operations, postoperative infections, postoperative abdominal abscess, major complications, and death. Results: Preoperative and intraoperative factors were similar in both groups. Operative mortality was 3 of 19 in group 1 and 8 of 188 in group 2 (P=.07). The mean number of major complications tended to be higher in group 1 (1.5 vs 0.5, P=.07). Despite no difference between the incidences of overall postoperative infections, patients in group 1 were much more likely to develop an abdominal abscess (4 of 19 vs 3 of 188, P=.002). Logistic regression established that patients undergoing splenectomy and synchronous GI or biliary surgery were 25 times more likely to develop an intra-abdominal abscess than were patients with splenectomy alone, even controlling for confounding factors (odds ratio, 24.7; 95% confidence interval, 3.1 to 196;P=.002). Conclusions: Synchronous GI or biliary surgery with splenectomy for hematologic disease increases the risk of intra-abdominal abscess and should be avoided. Complication and mortality rates may also be increased.