Splenectomy, indications and outcomes: a 12-year experience in a community hospital

Abstract

Background: Splenectomy volume has declined as improved imaging, nonoperative management of blunt trauma, and novel medical therapies such as rituximab and thrombopoietin receptor agonists have narrowed its indications, making elective splenectomy uncommon and raising concern about maintaining operative proficiency.

Methods: We conducted a single-center retrospective chart review at Flushing Hospital Medical Center in Queens, NY of patients who underwent splenectomy between October 2012 and March 2025. Eligible patients were identified by institutional record review using diagnostic codes and confirmed by chart review. Inclusion criteria were patients 18 years and older who underwent splenectomy for any indication. Patients under the age of 18 or who required transfer to another institution were excluded. Data collection included patient demographics, medications, splenectomy indication, emergent versus elective, surgical approach (laparoscopic, robotic, or open), length of stay (LOS), morbidity, and in-hospital mortality. Descriptive statistics were calculated; chi-square tests with Bonferroni correction and Fisher's exact test assessed categorical relationships, and Pearson's correlations assessed continuous variables. IRB approval was obtained.

Results: Twenty-two patients were included (mean age 59.2±18.7 years; 54.5% male; 63.6% Hispanic), with hypertension (45.5%) and diabetes (22.7%) the most prevalent comorbidities; 50% were on steroids and approximately one-third on immunosuppressive therapy or chemotherapy. Most cases were elective (90.9%) and open (68.2%), with robotic (18.2%) and laparoscopic (9.1%) approaches less common. Immune thrombocytopenic purpura and neoplasm were the leading indications (40.9% each), while 9.1% (n=2) were urgent or emergent for massive splenomegaly. Postoperative bleeding occurred in 22.7% (n=5/22), mean LOS was 8.4±7.3 days, readmission rate was 27.3%, and there was no mortality. Surgical indication was significantly associated with complication type (p<0.03), and average volume was 2 cases per year.

Conclusions: Splenectomy has become a rare elective operation but remains highly effective and often life-saving; community and teaching surgical services should deliberately maintain minimally invasive splenectomy skills, recognizing that outcomes vary by indication.