چکیده (انگلیسی):

Background: Splenectomy is a common surgical procedure, but few reports focus
on nontraumatic splenectomies. The aim of this study was to determine the predictors of
morbidity and mortality of patients submitted to elective nontraumatic splenectomy.
Methods: A descriptive cross-sectional study of 152 consecutive, nonselected, nontraumatic
patients operated on by splenectomy between 1996 and 2010 was carried out. Clinical, laboratory,
and surgical data, histological findings, perioperative mortality, and postoperative
complications according to Clavien-Dindo classification, were recorded. Factors related to
morbidity and mortality were analyzed.
Results: Of the 152 patients (89 male and 63 female; mean age 49.8
17.8 years), 74 (48.7%)
were operated on for malignant hematologic disorders, 44 for benign hematologic process, and
34 for other nonhematologic disorders. The spleen was enlarged in 95 patients (62.5%) and 78
patients (51.3%) had hypersplenism. The overall complications rate was 40.1%: Grades I and II
in 27 cases (17.7%), and Grades III and IV in 23 patients (15.1%). Perioperative mortality was
7.2% (11 patients). In univariate analysis, significant negative predictors for morbidity were
age (p Z 0.004), anemia (p Z 0.03), leukocytosis (p Z 0.016), and blood transfusions
(p < 0.001). In the multivariate analysis, only the need for blood transfusion remained as an
independent prognostic factor (p Z 0.001). Related to mortality, negative prognostic factors
were age (p Z 0.003), leukocytosis (p Z 0.048), American Society of Anesthesiologists (ASA)
score (p < 0.001), blood transfusion (p < 0.001), pleural effusion (p Z 0.031), and pneumonia
(p Z 0.001). Pneumonia remained an independent prognostic factor of mortality (p Z 0.024).
Conclusion: Blood loss is the most important prognostic factor for postoperative complications
after nontraumatic splenectomies. Pneumonia is the main prognosis factor for perioperative
mortality.