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Nationwide outcomes of nontrauma splenectomy

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Abstract

Introduction

Due to the impact of LeapFrog and many scientific publications, regionalization for solid-organ operations gained momentum in the early 2000s. This study examines the effects of regionalization for medically indicated, nontrauma splenectomies (NTSs) in the USA.

Methods

The Nationwide Inpatient Sample (NIS) data were analyzed for NTS based on International Classification of Disease Ninth Revision Clinical Modification codes for 1998–1999 (the 1990s) and 2008–2009 (the 2000s). The hospitals in the NIS were stratified by volume and divided into high volume (HV), medium volume, and low-volume (LV) terciles based on the annual volume of splenectomies performed (<5, 5–10, and 11+, respectively). Demographics, comorbidities, complications, admission status, and in-patient mortality were recorded. Univariate and multivariate statistical analyses were utilized.

Results

NIS recorded 4,293 NTS performed in the 1990s and 3,384 in the 2000s. Despite the decrease in operative volume, regionalization did not occur: in the first decade 30, 37, and 33 % of cases occurred in LV center (LVC), medium volume center, and HV center (HVC), respectively, compared with 34, 30, and 36 % in the second decade (p < 0.001). Patients were older in low-volume hospitals (LVC) than in high-volume hospitals (HVC) in both decades (in the 1990s: 45.3 vs. 52.7 years, p < 0.001; in the 2000s: 49.1 vs. 54.5 years, p < 0.001). The Charlson Comorbidity Index scores were not different in LVC compared with HVC in both decades (the 1990s: 1.31 vs. 1.23, p = 0.73; the 2000s: 1.54 vs. 1.41, p = 0.72). In both decades, LVC had more emergent admissions than HVC (20.3 vs. 16.8 %, p = 0.03; 28.8 vs. 19.5 %, p < 0.001). Complication rates were higher in LVC in both decades (the 1990s: 16.9 vs. 13.6 %, p = 0.02; the 2000s: 19.8 vs. 15.5 %, p = 0.006). Mortality was not different for HVC and LVC in both decades (the 1990s: 3.75 vs. 4.27, p = 0.49; the 2000s: 2.94 vs. 4.03, p = 0.15).

Conclusions

NTS has not been affected by regionalization, which is dissimilar to other solid-organ abdominal procedures. Indeed, the benefit of regionalization for splenectomy has not been established.

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Disclosures

Dr. B. Todd Heniford has a paid speaker’s consulting arrangement with Ethicon, Inc. and LifeCell and has accepted research funding from Synovis. Dr. Vedra Augenstein has a paid speaker’s consulting arrangement with Bard. Drs. Alla Zemlyak, Paul Colavita, Ronald Sing, Amy Lincourt, and Ms. Amanda Walters have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, MEB 601, Charlotte, NC, 28203, USA

    A. Y. Zemlyak, P. D. Colavita, V. A. Augenstein, A. L. Walters, A. E. Lincourt, R. F. Sing & B. Todd Heniford

Authors
  1. A. Y. Zemlyak
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  2. P. D. Colavita
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  3. V. A. Augenstein
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  4. A. L. Walters
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  5. A. E. Lincourt
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  6. R. F. Sing
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  7. B. Todd Heniford
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Corresponding author

Correspondence to B. Todd Heniford.

Additional information

Presented at the SAGES 2013 Annual Meeting, 17–20 April 2013, Baltimore, MD.

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Zemlyak, A.Y., Colavita, P.D., Augenstein, V.A. et al. Nationwide outcomes of nontrauma splenectomy. Surg Endosc 28, 1063–1067 (2014). https://doi.org/10.1007/s00464-013-3287-7

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  • DOI: https://doi.org/10.1007/s00464-013-3287-7

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