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Temporal trends and outcome of splenectomy in adults with immune thrombocytopenia in the USA

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Abstract

Splenectomy is one of the treatments of immune thrombocytopenia (ITP) with a high response rate. However, it is an irreversible procedure that can be associated with morbidity in this setting. Our aim was to study the trends of splenectomy in adults with ITP, and the factors associated with splenectomy and resource utilization during these hospitalizations. We used the National (Nationwide) Inpatient Sample (NIS) to identify hospitalizations for adult patients with a principal diagnosis of ITP between 2007 and 2017. The primary outcome was the splenectomy trend. Secondary outcomes were (1) incidence of ITP trend, (2) in-hospital mortality, length of stay, and total hospitalization costs after splenectomy trend, and (3) independent predictors of splenectomy, length of stay, and total hospitalization costs. A total of 36,141 hospitalizations for ITP were included in the study. The splenectomy rate declined over time (16% in 2007 to 8% in 2017, trend p < 0.01) and so did the in-hospital mortality after splenectomy. Of the independent predictors of splenectomy, the strongest was elective admissions (adjusted odds ratio [aOR]: 22.1, 95% confidence interval [CI]:17.8–27.3, P < 0.01), while recent hospitalization year, older age, and Black (compared to Caucasian) race were associated with lower odds of splenectomy. Splenectomy tends to occur during elective admissions in urban medical centers for patients with private insurance. Despite a stable ITP hospitalization rate over the past decade and despite listing splenectomy as a second-line option for management of ITP in major guidelines, splenectomy rates consistently declined over time.

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Funding

Funding was provided by the American University of Beirut, Naef K. Basile Cancer Institute.

Author information

Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut School of Medicine, Beirut, Lebanon

    Antoine Finianos & Ali Taher

  2. Department of Medicine, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA

    Hata Mujadzic

  3. Division of Surgery, Prisma Health Upstate, Greenville, SC, USA

    Heather Peluso

  4. Division of Plastic Surgery, Department of Surgery, Prisma Health/University of South Carolina School of Medicine, Columbia, SC, USA

    Tarik Mujadzic

  5. Division of Gastroenterology, Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA

    Marwan S. Abougergi

  6. Catalyst Medical Consulting, Simpsonville, SC, USA

    Marwan S. Abougergi

Authors
  1. Antoine Finianos
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  2. Hata Mujadzic
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  3. Heather Peluso
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  4. Tarik Mujadzic
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  5. Ali Taher
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  6. Marwan S. Abougergi
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Contributions

Antoine Finianos and Ali Taher contributed to the study conception and design. Data collection and analysis were performed by Marwan S. Abougergi. The first draft of the manuscript was written by Antoine Finianos, Hata Mujadzic, Tarik Mujadzic, Heather Peluso, and Marwan S. Abougergi. All authors commented on previous versions of the manuscript, read and approved the final manuscript.

Corresponding author

Correspondence to Marwan S. Abougergi.

Ethics declarations

Ethics approval

This retrospective review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Prisma Health-Upstate, Greenville South Carolina.

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This study is a retrospective review of already collected and de-identified data, thus, informed consent was not obtained

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The authors declare no competing interests.

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Appendix

Appendix

ICD-9 CM codes:

Immune thrombocytopenia:

287.31

Splenectomy:

Procedural ICD-9 CM code: 41.5

Thrombosis:

Clinical Classifications Software (CCS) diagnosis codes 116 and 118

Sepsis:

CCS diagnosis code: 2

Steroid use:

V58.65

Traumatic intracranial hemorrhage:

800.2x, 800.3x, 800.7x, 800.8x, 801.2x, 801.3x, 801.7x, 801.8x, 803.2x, 803.3x,803.7, 803.8x, 804.2x, 804.3x, 804.7x, 804.8x, 852.00-06, 852.09, 852.10-16, 852.19, 852.20-26, 852.29, 852.30-36, 852.39, 852.40-46, 852.49, 852.50-56, 852.59, 853.00- 06, 853.09, 853.10-16, 853.19

Nontraumatic intracranial hemorrhage:

430, 431, 432.0, 432.1, 432.9

Upper gastrointestinal hemorrhage:

530.7, 531.0, 531.00, 531.01, 531.2, 531.20, 531.21, 531.4, 531.40, 531.41, 531.6, 531.60 ,531.61, 532.0, 532.00, 532.01, 532.2, 532.20, 532.21, 532.4, 532.40, 532.41, 532.6, 532.60, 532.61, 533.0,533.00, 533.01, 533.2, 533.20, 533.21, 533.4, 533.40, 533.41, 533.6, 533.60, 533.61, 534.0, 534,00, 534.01, 534.2, 534.20, 534.21, 534.4, 534.40, 534.41, 534.6, 534.60, 534.61, 535.01, 535.11, 535.21, 535.31, 535.41, 535.51, 535.61, 535.71, 537.83, 530.82, 537.84, 578.0, 530.21, 578.9, 285.1, 578.1

Lower GI bleed:

569.85, 455.2, 455.5, 455.8

Non-specified GI bleeding:

578.1, 578.9, 285.1

Non-GI bleeding:

078.6, 246.3, 360.43, 362.43, 362.81, 363.6, 363.61, 363.62, 363.72, 372.72, 374.81, 376.32, 377.42, 379.23, 380.31, 423.0, 459.0, 596.7, 608.82, 665.7, 665.70, 665.71, 665.72, 665.74, 767.11, 782.7, 784.7, 784.8, 786.3, 864.01, 864.11, 865.01, 865.11, 866.01, 866.11, 997.02, 998.1, 998.11, 998.12

ICD-10 CM codes:

Immune thrombocytopenia:

D69.3

Splenectomy:

Procedural ICD-10 CM code: 07TP0ZZ and 07TP4ZZ

Thrombosis:

I51.3, I63.0, I63.3, I63.6, I67.6, K64.5, I74.xxxx. I82.xxxx except "82.0 and I82.1

Sepsis:

A40.xxxx, A41.xxxx, A02.1, A22.7, A26.7, A32.7, A42.7, A54.86, B37.7, R65.2

Steroid use:

Z79.52

Traumatic intracranial hemorrhage:

S06.5xxx, S06.6xxx, S06.34xx, S06.35xx, S06.36xx

Nontraumatic intracranial hemorrhage:

I60.xxxx, I61.xxxx, I62.xxxx

Upper gastrointestinal hemorrhage:

`K22.11, K22.6, K25.0, K25.2, K25.4, K25.6, K26.0, K26.2, K26.4, K26.6, K27.0, K27.2, K27.4, K27.6, K28.0, K28.2, K28.4, K28.6, K29.01, K29.21, K29.31, K29.41, K29.51, K29.61, K29.71, K29.81, K29.91, K31.811, K31.82, K92.1, K92.2, D62, K92.0

Lower GI bleed:

K57.11, K57.31, K57.51, K57.91, K62.5, K55.21, K64.xxxx

Non-specified GI bleeding:

K92.1, K92.2, D62

Non-GI bleeding:

A98.5, I31.2, R58, R36.1, O71.7, S36.112, S36.029A, S36.021A, S36.020A, H44.81xx, H35.73xx, H35.6xxx, H31.30xx, H31.31xx, H31.41xx, H11.3xxx, H47.02xx, H05.23xx, H43.1xxx, H61.12xx, R04.xxxx, S37.01xx, S37.02xx, I97.4xxx, I97.6xxx

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Finianos, A., Mujadzic, H., Peluso, H. et al. Temporal trends and outcome of splenectomy in adults with immune thrombocytopenia in the USA. Ann Hematol 100, 941–952 (2021). https://doi.org/10.1007/s00277-021-04449-4

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