CAUSES OF DEATH AMONG PATIENTS SURVIVING AT LEAST ONE-YEAR FOLLOWING SPLENECTOMY

BACKGROUND: TO assess the mortality (mostly long-term sequelae) of pat ients undergoing splenectomy, we carried out a population-based study in Sweden. METHODS: Using the unique personal identification number as signed to each Swedish resident, we linked centralized hospitalization records with nationwide mortality data, After initially assessing ris ks within the first 12 months after splenectomy, we excluded deaths du ring the first year and computed standardized mortality ratios (SMRs) for 1,297 patients splenectomized for external trauma and 991 surgical ly treated for nonmalignant conditions of adjacent organs who were ali ve at 12 months following surgery. The general Swedish population was used as the comparison. RESULTS: Both men and women undergoing splenec tomy for external trauma had a 1.6-fold (SMR = 1.6) significantly elev ated mortality risk, due mainly to circulatory diseases (particularly thromboembolism), alcoholism, digestive disorders. and external causes . Men also had a 28-fold increased mortality from septicemia and an ex cess of liver cirrhosis (mostly alcohol-related). Patients of both gen ders splenectomized for nonmalignant conditions had small but signific antly elevated mortality overall (SMR = 1.4 to 1.5) reflecting excess risks for malignancies, diseases of blood-forming organs, external cau ses, and circulatory, respiratory, and digestive disorders, In additio n, men had increased mortality from thromboembolism and pneumonia whil e women experienced elevated risks from septicemia. CONCLUSION: The ex cess mortality resulted from functional postsplenectomy defects (inclu ding sepsis and thromboembolism), behaviors increasing risk of traumat ic splenic injury (eg, alcoholism), damage to other organs from the ex ternal trauma (eg, traumatic injury to the central nervous system/spin al cord), or the same or recurrent nonmalignant conditions for which s urgery was performed (eg, gastric and duodenal ulcers).