Postsplenectomy morbidity and mortality in patients with immune thrombocytopenic purpura: A national cohort study
Background We sought to identify factors associated with 30‐day morbidity, and their impact on 30‐day mortality, among patients undergoing splenectomy for immune thrombocytopenic purpura (ITP). Methods Using the ACS‐NSQIP database, patients undergoing splenectomy for ITP were identified (2005–2019),...
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| Veröffentlicht in: | Journal of surgical oncology 2022-09, Vol.126 (4), p.718-727 |
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| creator | Sharon, Cimarron E. Straker, Richard J. Perry, Nikhita Miura, John T. Karakousis, Giorgos C. |
| description | Background
We sought to identify factors associated with 30‐day morbidity, and their impact on 30‐day mortality, among patients undergoing splenectomy for immune thrombocytopenic purpura (ITP).
Methods
Using the ACS‐NSQIP database, patients undergoing splenectomy for ITP were identified (2005–2019), and those with and without postoperative complications within 30 days of surgery were compared.
Results
Of 2483 patients evaluated, 280 (11.3%) developed 30‐day morbidity: infection (n= 145 [5.8%]), venous thromboembolism (n = 71 [2.9%]), acute renal failure (n = 7 [0.3%]), respiratory failure (n = 40 [1.6%]), cardiac arrest/myocardial infarction (n = 16 [0.6%]), cerebrovascular accident (n = 4 [0.2%]), or postoperative blood transfusion (n = 62 [2.5%]). Risk‐factors for 30‐day morbidity included age ≥50 years (odds ratio [OR] 1.50, p = 0.020), body mass index ≥30 kg/m2 (OR 1.45, p = 0.023), functional dependence (OR 2.90, p = 0.009), preoperative albumin |
| doi_str_mv | 10.1002/jso.26986 |
| format | Article |
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We sought to identify factors associated with 30‐day morbidity, and their impact on 30‐day mortality, among patients undergoing splenectomy for immune thrombocytopenic purpura (ITP).
Methods
Using the ACS‐NSQIP database, patients undergoing splenectomy for ITP were identified (2005–2019), and those with and without postoperative complications within 30 days of surgery were compared.
Results
Of 2483 patients evaluated, 280 (11.3%) developed 30‐day morbidity: infection (n= 145 [5.8%]), venous thromboembolism (n = 71 [2.9%]), acute renal failure (n = 7 [0.3%]), respiratory failure (n = 40 [1.6%]), cardiac arrest/myocardial infarction (n = 16 [0.6%]), cerebrovascular accident (n = 4 [0.2%]), or postoperative blood transfusion (n = 62 [2.5%]). Risk‐factors for 30‐day morbidity included age ≥50 years (odds ratio [OR] 1.50, p = 0.020), body mass index ≥30 kg/m2 (OR 1.45, p = 0.023), functional dependence (OR 2.90, p = 0.009), preoperative albumin <3.5 g/dL (OR 2.10, p < 0.001), preoperative platelets <30 000/μL (OR 1.54, p = 0.020), open surgical approach (OR 2.32, p < 0.001), and inpatient status before surgery (OR 1.85, p = 0.040). Among patients at low‐risk for 30‐day morbidity (no risk‐factors present), the 30‐day morbidity rate was 5.0% versus 41.5% for ≥5 risk‐factors (p < 0.001). Thirty‐day mortality was 1.2%.
Conclusions
Thirty‐day morbidity and mortality are low with splenectomy for ITP. Select patients have particularly low perioperative risk and may benefit from early splenectomy if initial medical therapy fails.</description><identifier>ISSN: 0022-4790</identifier><identifier>EISSN: 1096-9098</identifier><identifier>DOI: 10.1002/jso.26986</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc</publisher><subject>Cohort analysis ; immune thrombocytopenic purpura ; Morbidity ; Mortality ; outcomes ; Purpura ; Respiratory failure ; splenectomy</subject><ispartof>Journal of surgical oncology, 2022-09, Vol.126 (4), p.718-727</ispartof><rights>2022 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2206-ce95bd8ca5927aedbf6b75d4be13f05bb5d966b173f7736fdf3569d34ea6c4613</cites><orcidid>0000-0002-2263-3576 ; 0000-0002-8398-3297</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjso.26986$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjso.26986$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids></links><search><creatorcontrib>Sharon, Cimarron E.</creatorcontrib><creatorcontrib>Straker, Richard J.</creatorcontrib><creatorcontrib>Perry, Nikhita</creatorcontrib><creatorcontrib>Miura, John T.</creatorcontrib><creatorcontrib>Karakousis, Giorgos C.</creatorcontrib><title>Postsplenectomy morbidity and mortality in patients with immune thrombocytopenic purpura: A national cohort study</title><title>Journal of surgical oncology</title><description>Background
We sought to identify factors associated with 30‐day morbidity, and their impact on 30‐day mortality, among patients undergoing splenectomy for immune thrombocytopenic purpura (ITP).
Methods
Using the ACS‐NSQIP database, patients undergoing splenectomy for ITP were identified (2005–2019), and those with and without postoperative complications within 30 days of surgery were compared.
Results
Of 2483 patients evaluated, 280 (11.3%) developed 30‐day morbidity: infection (n= 145 [5.8%]), venous thromboembolism (n = 71 [2.9%]), acute renal failure (n = 7 [0.3%]), respiratory failure (n = 40 [1.6%]), cardiac arrest/myocardial infarction (n = 16 [0.6%]), cerebrovascular accident (n = 4 [0.2%]), or postoperative blood transfusion (n = 62 [2.5%]). Risk‐factors for 30‐day morbidity included age ≥50 years (odds ratio [OR] 1.50, p = 0.020), body mass index ≥30 kg/m2 (OR 1.45, p = 0.023), functional dependence (OR 2.90, p = 0.009), preoperative albumin <3.5 g/dL (OR 2.10, p < 0.001), preoperative platelets <30 000/μL (OR 1.54, p = 0.020), open surgical approach (OR 2.32, p < 0.001), and inpatient status before surgery (OR 1.85, p = 0.040). Among patients at low‐risk for 30‐day morbidity (no risk‐factors present), the 30‐day morbidity rate was 5.0% versus 41.5% for ≥5 risk‐factors (p < 0.001). Thirty‐day mortality was 1.2%.
Conclusions
Thirty‐day morbidity and mortality are low with splenectomy for ITP. Select patients have particularly low perioperative risk and may benefit from early splenectomy if initial medical therapy fails.</description><subject>Cohort analysis</subject><subject>immune thrombocytopenic purpura</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>outcomes</subject><subject>Purpura</subject><subject>Respiratory failure</subject><subject>splenectomy</subject><issn>0022-4790</issn><issn>1096-9098</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp1kEtLAzEUhYMoWB8L_0HAjS7GJvNIJu5K8Umhgroe8hqaMpNMkwwy_97UuhKEC5fD_c7hcgC4wugOI5TPt8Hd5YTV5AjMMGIkY4jVx2CWbnlWUoZOwVkIW4QQY6Scgd2bCzEMnbZaRtdPsHdeGGXiBLlVexV5t1fGwoFHo20M8MvEDTR9P1oN48a7Xjg5RTdoayQcRp-G38MFtMngLO-gdJsUBEMc1XQBTlreBX35u8_B5-PDx_I5W62fXpaLVSbzHJFMalYJVUtesZxyrURLBK1UKTQuWlQJUSlGiMC0aCktSKvaoiJMFaXmRJYEF-fg5pA7eLcbdYhNb4LUXcetdmNockLrMk_hdUKv_6BbN_r0eKIoQgXGJS0SdXugpHcheN02gzc991ODUbMvv0nlNz_lJ3Z-YL9Mp6f_web1fX1wfAPXRolI</recordid><startdate>20220901</startdate><enddate>20220901</enddate><creator>Sharon, Cimarron E.</creator><creator>Straker, Richard J.</creator><creator>Perry, Nikhita</creator><creator>Miura, John T.</creator><creator>Karakousis, Giorgos C.</creator><general>Wiley Subscription Services, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2263-3576</orcidid><orcidid>https://orcid.org/0000-0002-8398-3297</orcidid></search><sort><creationdate>20220901</creationdate><title>Postsplenectomy morbidity and mortality in patients with immune thrombocytopenic purpura: A national cohort study</title><author>Sharon, Cimarron E. ; Straker, Richard J. ; Perry, Nikhita ; Miura, John T. ; Karakousis, Giorgos C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2206-ce95bd8ca5927aedbf6b75d4be13f05bb5d966b173f7736fdf3569d34ea6c4613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Cohort analysis</topic><topic>immune thrombocytopenic purpura</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>outcomes</topic><topic>Purpura</topic><topic>Respiratory failure</topic><topic>splenectomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sharon, Cimarron E.</creatorcontrib><creatorcontrib>Straker, Richard J.</creatorcontrib><creatorcontrib>Perry, Nikhita</creatorcontrib><creatorcontrib>Miura, John T.</creatorcontrib><creatorcontrib>Karakousis, Giorgos C.</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sharon, Cimarron E.</au><au>Straker, Richard J.</au><au>Perry, Nikhita</au><au>Miura, John T.</au><au>Karakousis, Giorgos C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postsplenectomy morbidity and mortality in patients with immune thrombocytopenic purpura: A national cohort study</atitle><jtitle>Journal of surgical oncology</jtitle><date>2022-09-01</date><risdate>2022</risdate><volume>126</volume><issue>4</issue><spage>718</spage><epage>727</epage><pages>718-727</pages><issn>0022-4790</issn><eissn>1096-9098</eissn><abstract>Background
We sought to identify factors associated with 30‐day morbidity, and their impact on 30‐day mortality, among patients undergoing splenectomy for immune thrombocytopenic purpura (ITP).
Methods
Using the ACS‐NSQIP database, patients undergoing splenectomy for ITP were identified (2005–2019), and those with and without postoperative complications within 30 days of surgery were compared.
Results
Of 2483 patients evaluated, 280 (11.3%) developed 30‐day morbidity: infection (n= 145 [5.8%]), venous thromboembolism (n = 71 [2.9%]), acute renal failure (n = 7 [0.3%]), respiratory failure (n = 40 [1.6%]), cardiac arrest/myocardial infarction (n = 16 [0.6%]), cerebrovascular accident (n = 4 [0.2%]), or postoperative blood transfusion (n = 62 [2.5%]). Risk‐factors for 30‐day morbidity included age ≥50 years (odds ratio [OR] 1.50, p = 0.020), body mass index ≥30 kg/m2 (OR 1.45, p = 0.023), functional dependence (OR 2.90, p = 0.009), preoperative albumin <3.5 g/dL (OR 2.10, p < 0.001), preoperative platelets <30 000/μL (OR 1.54, p = 0.020), open surgical approach (OR 2.32, p < 0.001), and inpatient status before surgery (OR 1.85, p = 0.040). Among patients at low‐risk for 30‐day morbidity (no risk‐factors present), the 30‐day morbidity rate was 5.0% versus 41.5% for ≥5 risk‐factors (p < 0.001). Thirty‐day mortality was 1.2%.
Conclusions
Thirty‐day morbidity and mortality are low with splenectomy for ITP. Select patients have particularly low perioperative risk and may benefit from early splenectomy if initial medical therapy fails.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc</pub><doi>10.1002/jso.26986</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2263-3576</orcidid><orcidid>https://orcid.org/0000-0002-8398-3297</orcidid></addata></record> |
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| subjects | Cohort analysis immune thrombocytopenic purpura Morbidity Mortality outcomes Purpura Respiratory failure splenectomy |
| title | Postsplenectomy morbidity and mortality in patients with immune thrombocytopenic purpura: A national cohort study |
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