Elective splenectomy in the elderly - perioperative and long-term course

Background: The hazards of elective splenectomy in the elderly have not bee n thoroughly investigated. The aim was to assess such a well-defined cohort with respect to perioperative and long-term outcome. Methods: Fifty-two co nsecutively splenectomised patients during the period 1971-1995, aged 65 ye ars or older, were followed until death (44 cases) or the end of 1999 (8 ca ses). Results: No intraoperative deaths occurred, while three patients (5.8 %) died postoperatively in the 1970s. Twenty-four patients suffered from th irty-four postoperative complications, dominated by infections and haematom as. No differences were seen comparing patients with and without complicati ons related to the American Society of Anesthesiologists' classes, total tr ansfusion rate, steroid medication, preoperative risk diseases, "giant sple ens" or the time period during which the operations were performed. In 69% of the patients, the splenectomy was beneficial. During the long-term follo wup, 25 patients suffered from 59 infectious and thromboembolic episodes an d 1 surgical complication. The dominating causes of death were the primary disease (29%), myocardial infarction (20%), sepsis (12%) and cerebrovascula r lesions (12%), i.e. not directly related to late effects of the operation . Conclusion: Highrisk patients older than 65 years with haematological dis orders can safely undergo splenectomy with a low mortality rate and a reaso nable rate of morbidity. The long-term course demonstrates a fair response rate, minimal surgically related complications, but thromboembolic and infe ctious events, and the majority of deaths unrelated to late effects of the splenectomy.