The impact of cirrhosis on the postoperative outcomes of patients undergoing splenectomy: Propensity score matched analysis of the 2011-2017 US hospital database.

Abstract

BACKGROUND & OBJECTIVE\nWhile splenectomy is performed for various trauma and non-trauma indications, there is little information about the impact of cirrhosis on the post-splenectomy outcomes, despite the intricate physiological and vascular connection between the liver and the spleen.\n\n\nMETHODS\n2011-2017 National Inpatient Sample was used to select patient cases who underwent the splenectomy procedure, who were further stratified using cirrhosis. The cirrhosis-absent controls were matched to the study cohort using propensity score matching with nearest neighbor matching method. Endpoints included mortality, length of stay, hospitalization costs, and postoperative complications.\n\n\nRESULTS\nThere were 675 patients with cirrhosis and 675 matched controls identified from the database. Cirrhosis cohort had higher mortality (20.0 vs 7.26%, p\u2009<\u20090.001, OR = 3.19, 95% CI = 2.26-4.52) and hospitalization costs ($210,716 vs $186,673, p\u2009=\u20090.003), but shorter length of stay (11.8 vs 12.5d, p\u2009=\u20090.04). In terms of complications, cirrhosis cohorts had higher postoperative bleeding (7.26 vs 4.3%, p\u2009=\u20090.027, OR = 1.74, 95% CI = 1.09-2.80) and shock (3.7 vs 1.04%, p\u2009=\u20090.002, OR = 3.67, 95% CI = 1.58-8.54), and were more likely to be discharged to short-term hospitals and home with home health care. On multivariate analysis, presence of cirrhosis resulted in higher mortality (p\u2009<\u20090.001, aOR = 3.30, 95% CI = 2.33-4.69).\n\n\nCONCLUSIONS\nCirrhosis is an independent risk factor of postoperative mortality in patients undergoing splenectomy; given this finding, further precautious and multidisciplinary care should be rendered in these at-risk patients with cirrhosis in the setting of splenectomy.