Study of Patients Having Splenectomy Due to Trauma for Long Term Infectious and Vascular Complications.

Splenectomy, commonly performed for hematologic conditions, is followed by an increased risk of septicemia and arterial and deep venous thrombosis and pulmonary arterial hypertension. Most recent studies of post-splenectomy vascular complications focus primarily on patients with sickle cell disease, thalassemia, or hereditary stomatocytosis. However, the incidence and pathophysiology of complications in these patients is confounded by persistent hemolysis. Therefore, study of long term post-splenectomy infectious and vascular complications in patients without hemolysis or other serious medical conditions is indicated. Patients having splenectomy for trauma are often young and otherwise healthy so might be good candidates for investigation of post-splenectomy sequelae. To determine the feasibility of conducting a study of infectious and vascular complications following splenectomy for trauma, we retrospectively studied such patients admitted to Parkland Memorial Hospital, a 950 bed public hospital and the site of the Dallas metropolitan area’s primary trauma center. Using appropriate ICD-9 and CPT codes, three separate databases (hospital medical records, trauma registry, and professional billing compilation) were reviewed in order to identify patients ≥ age 18 yr. having total splenectomy for trauma during the past 15 years and to determine whether follow-up data were available in the records regarding subsequent vascular events or surrogate laboratory markers suggesting an increased risk of thrombosis. Between 1992 and 2006, 855 individuals had splenectomy, including 643 (75%) following trauma. The annual number of patients having splenectomy due to trauma did not decline during this period. A comprehensive chart review was performed on the 77 patients having splenectomy for trauma during 2003 and 2004. Records were unavailable in four patients, and 20 died of their injuries shortly after admission. Follow-up records of the remaining 53 patients - 26 (49%) of whom appeared to be discharged in good condition without serious sequelae - were reviewed to attempt to gather data regarding clinical features and laboratory test results. Post hospitalization follow-up occurred in only 9 (17%) of these 53 patients. Six had serious post-trauma complications (e.g., paraplegia); only three seen in follow-up more than six months following splenectomy appeared well. We conclude that complete splenectomy following trauma remains a common procedure. Retrospective review of these patients’ records does not permit evaluation of post-splenectomy complications. However, many patients were discharged shortly following splenectomy without other serious injuries. These patients could potentially be studied prospectively to assess the frequency, timing, and pathophysiology of infection, thrombosis, pulmonary arterial hypertension, and other complications of the post-splenectomy state without the confounder of hemolytic anemia.