Predictive factors of splenic injury in colorectal surgery: data from the Nationwide Inpatient Sample, 2006-2008

Abstract

Objectives: To determine frequency of splenic injury and to evaluate predictive risk factors of splenic injury during colorectal surgery.

Design: Retrospective database analysis.

Setting: The National Inpatient Sample database.

Patients: Patients who underwent a colorectal resection during the period from 2006 to 2008 in the United States.

Main outcome measures: Patient characteristics, patient comorbidities, type of pathology, type of resection, surgical technique used, type of admission, and teaching hospital status were evaluated for splenic injury during colorectal surgery.

Results: A total of 975,825 patients underwent colorectal resection during this period. Overall, the rate of splenic injury was 0.96%, of which 84.75% were treated with complete splenectomy (splenorrhaphy, 13.55%; partial splenectomy, 1.70%). The most common procedure associated with splenic injury was transverse colectomy (3.40%). Using multivariate regression analysis, we found that transverse colectomy (adjusted odds ratio [AOR], 5.30), left colectomy (AOR, 5.08), total colectomy (AOR, 2.85), open operation (AOR, 2.68), malignant tumor (AOR, 2.11), diverticulitis (AOR, 1.93), teaching hospital (AOR, 1.73), male sex (AOR 1.20), peripheral vascular disease (AOR, 1.14), and emergent admission (AOR, 1.06) were associated with a higher risk of splenic injury. There was no association between age, race, hypertension, diabetes, chronic lung disease, congestive heart failure, renal failure, liver disease, obesity, sigmoidectomy, proctectomy, ulcerative colitis, or Crohn disease and splenic injury.

Conclusions: Type of resection (transverse, total, or left colectomy), type of pathology (malignancy or diverticulitis), open operation, and teaching hospital are potent independent predictors of splenic injury. Male sex, peripheral vascular disease, and emergent admission are less effective predictors. Surgeons should be aware of these risk factors and inform patients accordingly. In higher-risk circumstances, it may be appropriate to consider prophylactic vaccination.