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Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database

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Abstract

Background

Nearly half of all incidental splenectomies caused by iatrogenic splenic injury occur during colorectal surgery. This study evaluates factors associated with incidental splenic procedures during colorectal surgery and their impact on short-term outcomes using a nationwide database.

Methods

Patients who underwent colorectal resections between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database according to Current Procedural Terminology codes. Patients were classified into two groups based on whether they underwent a concurrent incidental splenic procedure at the time of the colorectal procedure. All splenic procedures except a preoperatively intended splenectomy performed in conjunction with colon or rectal resections were considered as incidental. Perioperative and short-term (30 day) outcomes were compared between the groups.

Results

In total, 93633 patients who underwent colon and/or rectal resection were identified. Among these, 215 patients had incidental splenic procedures (153 open splenectomy, 17 laparoscopic splenectomy, 36 splenorraphy, and 9 partial splenectomy). Open colorectal resections were associated with a significantly increased likelihood of incidental splenic procedures (OR 6.58, p < 0.001) compared to laparoscopic surgery. Incidental splenic procedures were associated with increased length of total hospital stay (OR 1.25, p < 0.001), mechanical ventilation dependency (OR 1.62, p = 0.02), transfusion requirement (OR: 3.84, p < 0.001), re-operation requirement (OR 1.7, p = 0.005), and sepsis (OR: 2.03, p = 0.001). Short-term advantages of splenic salvage (splenorraphy or partial splenectomy) included shorter length of total hospital stay (p = 0.001) and decreased need for re-operation (p < 0.001).

Conclusions

Incidental splenic procedures during colorectal resections are associated with worse short-term outcomes. Use of the laparoscopic technique decreases the need for incidental splenic procedures.

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Acknowledgments

We would like to thank Amy Moore for her contribution in redaction process of the manuscript.

Disclosures

Drs. Isik, Aytac, Ashburn, Ozuner, Remzi, Costedio, and Gorgun have no conflicts of interest or financial ties to disclose.

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Ozgen Isik, Erman Aytac, Jean Ashburn, Gokhan Ozuner, Feza Remzi, Meagan Costedio & Emre Gorgun

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  1. Ozgen Isik
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  2. Erman Aytac
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  3. Jean Ashburn
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  4. Gokhan Ozuner
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  5. Feza Remzi
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  6. Meagan Costedio
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  7. Emre Gorgun
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Corresponding author

Correspondence to Emre Gorgun.

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Isik, O., Aytac, E., Ashburn, J. et al. Does laparoscopy reduce splenic injuries during colorectal resections? An assessment from the ACS-NSQIP database. Surg Endosc 29, 1039–1044 (2015). https://doi.org/10.1007/s00464-014-3774-5

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  • DOI: https://doi.org/10.1007/s00464-014-3774-5

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