The morbidity and mortality of pediatric splenectomy: Does prophylaxis make a difference?

Purpose: The aim of this study was to analyze the incidence of postsplenect omy sepsis morbidity and mortality after prophylaxis, in comparison with ou r previous 13-year study (1958 to 1970, inclusive). Methods: All patients who had splenectomy at the Hospital far Sick Children , Toronto, between 1971 and 1995, inclusive (to give a minimum of 2 years f or follow-up), were reviewed for infection and mortality. The criterion for classifying a patient as "infected" was the recovery of an invading encaps ulated organism from the blood culture in a patient admitted to the hospita l. Results: Of the 264 patients studied, 10 had a postsplenectomy infection (3 .8%); nine occurred in patients who underwent splenectomy between the ages of 0 and 5 years. Infection took place within 2 +/- 3 years (mean It SD) af ter splenectomy for the immunized patients and 11 +/- 5 days (mean +/- SD) for the nonimmunized children. A significant number of patients were admitt ed for an apparent respiratory infection, but no serum organisms were isola ted. One died of overwhelming sepsis, but the responsible organism was not identified. Conclusion: Although there has not been a decrease in the number of splenec tomies performed per year, the incidence of infection and mortality has dec reased by 47% and 88%, respectively, with prophylaxis. J Pediatr Surg 34:10 64-1067. Copyright (C) 1999 by W.B. Saunders Company.