IS SPLENECTOMY MORE DANGEROUS FOR MASSIVE SPLEENS

BACKGROUND: Reports vary about whether risks are greater for removal o f massive (greater than or equal to 1500 g) spleens than for smaller ( <1500 g) spleens. We sought to determine the hazards of splenectomy. M ETHODS: We reviewed 223 consecutive adults with elective splenectomies for hematologic diseases. Morbidity and mortality rates were combined with published data to create a meta-analysis. RESULTS: Patients with massive spleens are more likely to have postoperative complications ( relative risk [RR] 2.1, 95% confidence interval [CI] 1.3 to 3.4; P = 0 .003) and death (RR 4.7, 95% CI, 1.5 to 15.1; P = 0.01). However, when the investigation is restricted to comparable diagnoses, patients wit h massive spleens do not differ from those with smaller spleens regard ing complications (RR 1.4, 95% CI, 0.8 to 2.7; P = 0.3) or mortality ( RR 2.1, 95% CI, 0.5 to 9.7; P = 0.4). These observations are confirmed by metaanalysis. Furthermore, multivariate analysis indicts age as a critical risk of complications and death. CONCLUSIONS: Increased age a nd underlying illness are the predominant factors associated with morb idity and mortality following splenectomy for hematologic disease. Adj usting for age and diagnosis, spleen size is not a hazard. (C) 1998 by Excerpta Medica, Inc.