Aureen Ruby DCunha1,2, Ekta Rai3,4, Tarun John K Jacob1, Anup J Devasia5, Grace Rebekah6. 1. Department of Paediatric Surgery, Christian Medical College, Vellore, Tamilnadu, 632004, India. 2. Department of Paediatric Surgery, K.S. Hegde Medical Academy, Deralakatte, Mangaluru, Karnataka, 575018, India. 3. Department of Anaesthesia, Christian Medical College, Vellore, Tamilnadu, 632004, India. drektarai@yahoo.com. 4. Department of Biostatistics, Christian Medical College, Vellore, Tamilnadu, 632004, India. drektarai@yahoo.com. 5. Department of Haematology, Christian Medical College, Vellore, Tamilnadu, 632004, India. 6. Department of Biostatistics, Christian Medical College, Vellore, Tamilnadu, 632004, India.
Abstract
PURPOSE: Splenectomies though well-established in the successful management of several resistant haemoglobinopathies, have not been studied in detail in the paediatric population to assess the outcomes. We conducted this review to primarily assess the surgical and anaesthetic outcomes of paediatric splenectomies and secondarily highlight factors predictive for a high-risk splenectomy. METHODS: A 5 year retrospective chart review was made, and patient follow-up was done jointly using the hospital electronic medical records and telephonic calls. A p value of < 0.05 was considered significant. RESULTS: Among the 69 splenectomised children, 61% were male and the overall mean age was 10.2 years. The cohort consisted of patients with thalassemia (46%), ITP (30%), haemolytic anemia (19%) and 1 child each with lymphoma, splenic cyst and Kassabach Meritt syndrome. Most (96%) were electively operated and 23% were performed laparoscopically. 61% received intravenous analgesia and the mean volume of fluid administered intra-operatively was 21 ml/kg. There was no documented OPSI, and there was one mortality. The mean follow-up period was 43 months and the overall survival rate was 98.5%. CONCLUSIONS: Splenectomy was associated with a promising overall outcome. A greater pre-operative transfusion requirement, a larger sized spleen and increased fluid administration intra-operatively, were associated with a worse outcome.
PURPOSE: Splenectomies though well-established in the successful management of several resistant haemoglobinopathies, have not been studied in detail in the paediatric population to assess the outcomes. We conducted this review to primarily assess the surgical and anaesthetic outcomes of paediatric splenectomies and secondarily highlight factors predictive for a high-risk splenectomy. METHODS: A 5 year retrospective chart review was made, and patient follow-up was done jointly using the hospital electronic medical records and telephonic calls. A p value of < 0.05 was considered significant. RESULTS: Among the 69 splenectomised children, 61% were male and the overall mean age was 10.2 years. The cohort consisted of patients with thalassemia (46%), ITP (30%), haemolytic anemia (19%) and 1 child each with lymphoma, splenic cyst and Kassabach Meritt syndrome. Most (96%) were electively operated and 23% were performed laparoscopically. 61% received intravenous analgesia and the mean volume of fluid administered intra-operatively was 21 ml/kg. There was no documented OPSI, and there was one mortality. The mean follow-up period was 43 months and the overall survival rate was 98.5%. CONCLUSIONS: Splenectomy was associated with a promising overall outcome. A greater pre-operative transfusion requirement, a larger sized spleen and increased fluid administration intra-operatively, were associated with a worse outcome.
Authors: J H Graziano; S Piomelli; M Hilgartner; P Giardina; M Karpatkin; M Andrew; N LoIacono; C Seaman Journal: J Pediatr Date: 1981-11 Impact factor: 4.406