Skip to main content

Advertisement

SpringerLink
Log in

Splenectomy in older adults: indications and clinical outcomes

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

The aim of this study was to improve the understanding of the indications and associated outcomes among older adults undergoing splenectomy. Data regarding patients of age ≥60 years treated between 1998 and 2008 were reviewed. Fifty patients (age 71.6 ± 8) were identified. Common indications for splenectomy included idiopathic thrombotic purpura (26.0 %) and lymphoma (28.0 %). Patient co-morbidities included hypertension (54 %), coronary artery disease (24 %) and diabetes mellitus (20 %). Twenty-seven patients (54 %) underwent laparoscopic surgery; 23 (46 %) had open procedures; more than half of open splenectomies were conversions from attempted laparoscopy. Mean post-operative length of stay (LOS) was 5.9 ± 5 days (range 1–21). Two patients died in hospital; an additional three died within 6 months. Five patients were discharged to an extended care facility (ECF). Three patients required readmission within 30 days. Increased age was associated with need for ECF (p = 0.01). Increasing LOS, but not age, was associated with 6-month mortality (p = 0.04). Although we noted a 10 % in hospital mortality rate, splenectomy appears to be safe for carefully selected older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Finlayson E, Zhao S, Boscardin WJ, Fries BE, Landefeld CS, Dudley RA. Functional status after colon cancer surgery in elderly nursing home residents. J Am Geriatr Soc. 2012;60:967–73.

    Article  PubMed  Google Scholar 

  2. Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48:78–83.

    Article  PubMed  Google Scholar 

  3. Finlayson E, Fan Z, Birkmeyer JD. Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg. 2007;205:729–34.

    Article  PubMed  Google Scholar 

  4. Hamel MB, Henderson WG, Khuri SF, Daley J. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53:424–9.

    Article  PubMed  Google Scholar 

  5. Malani PN. Functional status assessment in preoperative evaluation of older adults. JAMA. 2009;302:1582–3.

    Article  PubMed  CAS  Google Scholar 

  6. Pultrum BB, Bosch DJ, Nijsten MW, et al. Extended esophagectomy in eldery patients with esophageal cancer: minor effect of age along in determining the postoperative course and survival. Ann Surg Oncol. 2010;17:1572–80.

    Article  PubMed  CAS  Google Scholar 

  7. Gigot JF, de Ville de Goyet J, Van Beers BE, et al. Laparoscopic splenectomy in adults and children: Experience with 31 patients. Surgery. 1996;119:384–9.

    Google Scholar 

  8. Kercher KW, Matthew BD, Walsh RM, Sing RF, Backus CL, Heniford BT. Laparoscopic splenectomy for massive splenomegaly. Am J Surg. 2002;183:192–6.

    Article  PubMed  Google Scholar 

  9. Terrosu G, Donini A, Baccarani U, et al. Laparoscopic versus open splenectomy in the management of splenomegaly: our preliminary experience. Surgery. 1998;124:839–43.

    Article  PubMed  CAS  Google Scholar 

  10. Berman RS, Yahanda AM, Mansfield PF, et al. Laparoscopic splenectomy in patients with hematologic malignancies. Am J Surg. 1999;178:530–5.

    Article  PubMed  CAS  Google Scholar 

  11. Rosen M, Brody F, Walsh RM, Tarnoff M, Malm J, Ponsky J. Outcome of laparoscopic splenectomy based on hematologic indication. Surg Endosc. 2002;16:272–9.

    Article  PubMed  CAS  Google Scholar 

  12. Fodor A, Molnar M, Krenacs L, et al. Autoimmune hemolytic anemia as a risk factor of poor outcome in patients with splenic marginal zone lymphoma. Pathol Oncol Res. 2009;15:597–603.

    Article  PubMed  Google Scholar 

  13. Zent CS, Ding W, Reinalda MS, et al. Autoimmune cytopenia in chronic lymphocytic leukemia/small lymphocytic lymphoma: changes in clinical presentation and prognosis. Leuk Lymphoma. 2009;50:1261–8.

    Article  PubMed  CAS  Google Scholar 

  14. Yoong YP, Kurtin PJ, Allmer C, et al. Efficacy of splenectomy for patients with mantle cell non-Hodgkin’s lymphoma. Leuk Lymph. 2001;42:1235–41.

    CAS  Google Scholar 

  15. Leung JM, Dzankic S. Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc. 2001;49:1080–5.

    Article  PubMed  CAS  Google Scholar 

  16. Udelnow A, Leinung S, Schreiter D, Schonfelder M, Wurl P. Impact of age on in-hospital mortality of surgical patients in a German university hospital. Arch Gerontol Geriatr. 2005;41:281–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported in part by the Veterans Affairs Ann Arbor Healthcare System’s Geriatric Research Education and Clinical Center (GRECC).

Author information

Author notes

  1. Lane L. Frasier

    Present address: Department of General Surgery, University of Wisconsin, Madison, USA

Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Lane L. Frasier

  2. Divisions of Geriatric and Palliative Medicine and Infectious Diseases, Department of Internal Medicine, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, MI, USA

    Preeti N. Malani

  3. Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA

    Kathleen M. Diehl

  4. Veterans Affairs Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center (GRECC), 2215 Fuller Road, Ann Arbor, MI, 48105, USA

    Preeti N. Malani

Authors
  1. Lane L. Frasier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Preeti N. Malani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kathleen M. Diehl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Preeti N. Malani.

About this article

Cite this article

Frasier, L.L., Malani, P.N. & Diehl, K.M. Splenectomy in older adults: indications and clinical outcomes. Int J Hematol 97, 480–484 (2013). https://doi.org/10.1007/s12185-013-1300-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-013-1300-5

Keywords

Search

Navigation