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Madenci AL, Armstrong LB, Kwon NK, Jiang W, Wolf LL, Koehlmoos TP, Ricca RL, Weldon CB, Haider AH, Weil BR. Incidence and risk factors for sepsis after childhood splenectomy. J Pediatr Surg 2019; 54:1445-1448. [PMID: 30029846 DOI: 10.1016/j.jpedsurg.2018.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Children who have undergone splenectomy may develop impaired immunologic function and heightened risk of overwhelming postsplenectomy infection. We sought to define the long-term rate of and risk factors for postsplenectomy sepsis. METHODS We leveraged the Military Health System Data Repository, a nationally representative claims database including >3 million children registered as dependents of members of the United States Armed Services (2005-2014). Inclusion criterion was splenectomy at age 18 years or prior. The primary outcome was hospitalization for sepsis. RESULTS Among 195 children who underwent splenectomy, 7% (n = 13) were hospitalized with sepsis, with an incidence of 1.8 (95% CI = 1.0-3.1) events per 100 person-years. The median time to sepsis was 224 days (IQR = 109-606) and 38% (5/13) of events occurred within the first postsplenectomy year. The postsplenectomy mortality rate was 1% (n = 3). After adjusting for underlying diagnosis, older age at splenectomy (HR = 0.90 per year, 95% CI = 0.81-0.99) was associated with decreased hazard of sepsis. CONCLUSIONS In a contemporary national cohort, the prevalence of postsplenectomy sepsis was 7% (1.8 events per 100 person-years). Although most presented during the first year after splenectomy, many (62%) sepsis events occurred later, suggesting that postsplenectomy immunologic dysfunction persists beyond one year. The immunologic consequences of asplenia must continue to be acknowledged, as postsplenectomy sepsis remains a serious concern. TYPE OF STUDY Prognosis study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Arin L Madenci
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States; Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; The Center for Surgery and Public Health, Boston, MA, United States.
| | - Lindsey B Armstrong
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | | | - Wei Jiang
- The Center for Surgery and Public Health, Boston, MA, United States
| | - Lindsey L Wolf
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; The Center for Surgery and Public Health, Boston, MA, United States
| | - Tracey P Koehlmoos
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Robert L Ricca
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Adil H Haider
- Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; The Center for Surgery and Public Health, Boston, MA, United States
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
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