Jose R Gonzalez-Porras1, Fernando Escalante2, Emilia Pardal3, Magdalena Sierra4, Luis J Garcia-Frade5, Santiago Redondo6, Maryam Arefi7, Carlos Aguilar8, Fernando Ortega9, Erik de Cabo10, Rosa M Fisac11, Oscar Sanz12, Carmen Esteban13, Ignacio Alberca1, Mercedes Sanchez-Barba14, Maria T Santos15, Abel Fernandez16, Tomas J Gonzalez-Lopez17. 1. Department of Hematology, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain. 2. Department of Hematology, Complejo Hospitalario Universitario de Leon, Leon, Spain. 3. Department of Hematology, Hospital Virgen del Puerto, Plasencia, Spain. 4. Department of Hematology, Hospital Virgen de la Concha, Zamora, Spain. 5. Department of Hematology, Hospital Universitario Rio Hortega, Valladolid, Spain. 6. Department of Hematology, Complejo Asistencial de Avila, Avila, Spain. 7. Department of Hematology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain. 8. Department of Hematology, Complejo Asistencial de Soria, Soria, Spain. 9. Department of Hematology, Complejo Asistencial de Palencia, Palencia, Spain. 10. Department of Hematology, Hospital del Bierzo, Ponferrada, Spain. 11. Department of Hematology, Complejo Asistencial de Segovia, Segovia, Spain. 12. Department of Surgery, Complejo Hospitalario Universitario de Leon, Leon, Spain. 13. Department of Surgery, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain. 14. Department of Statistics, Universidad de Salamanca, Salamanca, Spain. 15. Department of Coding, Hospital Universitario de Salamanca, Salamanca, Spain. 16. Department of Coding, Complejo Asistencial de Burgos, Burgos, Spain. 17. Department of Hematology, Complejo Asistencial de Burgos, Burgos, Spain.
Abstract
AIM: Few studies specifically focus on elderly splenectomized immune thrombocytopenia (ITP) patients. Older patients with ITP and excellent health are often excluded from surgery splenectomy. We aimed to compare the safety and efficacy of splenectomy in elderly and non-elderly ITP patients and to examine the effect of age on therapeutic response. MATERIAL AND METHODS: We carried out a retrospective analysis of a series of 218 patients who had undergone splenectomy for ITP. We compared the data from the elderly group (≥65 yrs, 57 patients) with the young group (<65 yrs, 162 patients). RESULTS: Surgical technique (laparoscopy or open laparotomy splenectomy) was comparable between the two age groups. The adjusted risk of major bleeding following splenectomy for elderly patients was three times that for young patients (OR 3.05, 95% CI: 1.44-6.52). The median duration of postoperative hospital stay was longer for elderly than for young patients (8 d vs. 4 d, P < 0.001). However, we identified a subgroup of elderly ITP patients, those aged between 65 and 70 yrs who had undergone laparoscopic splenectomy, with a low risk of postoperative complications. Of the 218 patients, 89% achieved a favorable response to splenectomy. A favorable response was significantly less common in elderly than in young people (79% vs. 92%, P = 0.005). However, we observed an acceptable long-term control of ITP in the elderly group, in which the probability of maintaining response for 14 yrs after splenectomy was 56%. CONCLUSIONS: Patients aged ≥65 yrs experienced negative effects on safety and efficacy outcomes of splenectomy for ITP, but further studies are needed to identify predictors of postsplenectomy outcomes in this group.
AIM: Few studies specifically focus on elderly splenectomized immune thrombocytopenia (ITP) patients. Older patients with ITP and excellent health are often excluded from surgery splenectomy. We aimed to compare the safety and efficacy of splenectomy in elderly and non-elderly ITP patients and to examine the effect of age on therapeutic response. MATERIAL AND METHODS: We carried out a retrospective analysis of a series of 218 patients who had undergone splenectomy for ITP. We compared the data from the elderly group (≥65 yrs, 57 patients) with the young group (<65 yrs, 162 patients). RESULTS: Surgical technique (laparoscopy or open laparotomy splenectomy) was comparable between the two age groups. The adjusted risk of major bleeding following splenectomy for elderly patients was three times that for young patients (OR 3.05, 95% CI: 1.44-6.52). The median duration of postoperative hospital stay was longer for elderly than for young patients (8 d vs. 4 d, P < 0.001). However, we identified a subgroup of elderly ITP patients, those aged between 65 and 70 yrs who had undergone laparoscopic splenectomy, with a low risk of postoperative complications. Of the 218 patients, 89% achieved a favorable response to splenectomy. A favorable response was significantly less common in elderly than in young people (79% vs. 92%, P = 0.005). However, we observed an acceptable long-term control of ITP in the elderly group, in which the probability of maintaining response for 14 yrs after splenectomy was 56%. CONCLUSIONS: Patients aged ≥65 yrs experienced negative effects on safety and efficacy outcomes of splenectomy for ITP, but further studies are needed to identify predictors of postsplenectomy outcomes in this group.
Authors: Luciano Tastaldi; David M Krpata; Ajita S Prabhu; Clayton C Petro; Ivy N Haskins; Arielle J Perez; Hemasat Alkhatib; Iago Colturato; Chao Tu; Alan Lichtin; Michael J Rosen; Steven Rosenblatt Journal: Surg Endosc Date: 2018-07-09 Impact factor: 4.584
Authors: Cindy Neunert; Deirdra R Terrell; Donald M Arnold; George Buchanan; Douglas B Cines; Nichola Cooper; Adam Cuker; Jenny M Despotovic; James N George; Rachael F Grace; Thomas Kühne; David J Kuter; Wendy Lim; Keith R McCrae; Barbara Pruitt; Hayley Shimanek; Sara K Vesely Journal: Blood Adv Date: 2019-12-10
Authors: Philip Yi Choi; Eileen Merriman; Ashwini Bennett; Anoop K Enjeti; Chee Wee Tan; Isaac Goncalves; Danny Hsu; Robert Bird Journal: Med J Aust Date: 2021-10-10 Impact factor: 12.776