Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up
Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up
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DOI：
10.3324/haematol.2013.092460
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发表时间：
2014-02-01
期刊：
影响因子：
10.1
通讯作者：
Landgren, Ola
中科院分区：
文献类型：
--
作者：
Kristinsson, Sigurdur Y.;Gridley, Gloria;Landgren, Ola
尽管腹部创伤后保留脾和保留脾的外科手术已经成为金标准，但在美国，每年仍有大约22,000例脾切除。感染，主要是由包裹体引起的，是脾切除术后最常见的并发症。最近，血栓形成和癌症已被认为是脾切除术后潜在的不良后果。在400多万名住院的美国退伍军人中，我们评估了感染、血栓栓塞症和癌症导致的发病率和死亡率，其中包括8149名没有患癌症的退伍军人，他们接受了脾切除术，并进行了长达27年的随访。使用队列数据的时间依赖泊松回归方法计算相对风险估计和95%的可信区间。脾切除患者因肺炎、脑膜炎和败血症(比率=1.9-3.4)；深静脉血栓形成和肺栓塞(比率=2.2)；某些实体肿瘤：口腔、食道、肝脏、结肠、胰腺、肺和前列腺(比率=1.3-1.9)；以及血液系统恶性肿瘤：非霍奇金淋巴瘤、霍奇金淋巴瘤、多发性骨髓瘤、急性髓系白血病、慢性淋巴细胞白血病、慢性髓系白血病和任何白血病(比率=1.8-6.0)而住院的风险增加。他们死于肺炎和败血症(比率比=1.6-3.0)；肺栓塞和冠状动脉疾病(比率比=1.4-4.5)；任何癌症：肝癌、胰腺癌和肺癌、非霍奇金淋巴瘤、霍奇金淋巴瘤和任何白血病(比率比=1.3-4.7)的风险也增加。许多观察到的风险在脾切除后10年以上增加。我们的结果强调了脾切除术后接种疫苗、监测和预防血栓的重要性。
Although preservation of the spleen following abdominal trauma and spleen-preserving surgical procedures have become gold standards, about 22,000 splenectomies are still conducted annually in the USA. Infections, mostly by encapsulated organisms, are the most well-known complications following splenectomy. Recently, thrombosis and cancer have become recognized as potential adverse outcomes post-splenectomy. Among more than 4 million hospitalized USA veterans, we assessed incidence and mortality due to infections, thromboembolism, and cancer including 8,149 cancer-free veterans who underwent splenectomy with a follow-up of up to 27 years. Relative risk estimates and 95% confidence intervals were calculated using time-dependent Poisson regression methods for cohort data. Splenectomized patients had an increased risk of being hospitalized for pneumonia, meningitis, and septicemia (rate ratios = 1.9-3.4); deep venous thrombosis and pulmonary embolism (rate ratios = 2.2); certain solid tumors: buccal, esophagus, liver, colon, pancreas, lung, and prostate (rate ratios = 1.3-1.9); and hematologic malignancies: non-Hodgkin lymphoma, Hodgkin lymphoma, multiple myeloma, acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia, and any leukemia (rate ratios = 1.8-6.0). They also had an increased risk of death due to pneumonia and septicemia (rate ratios = 1.6-3.0); pulmonary embolism and coronary artery disease (rate ratios = 1.4-4.5); any cancer: liver, pancreas, and lung cancer, non-Hodgkin lymphoma, Hodgkin lymphoma, and any leukemia (rate ratios = 1.3-4.7). Many of the observed risks were increased more than 10 years after splenectomy. Our results underscore the importance of vaccination, surveillance, and thromboprophylaxis after splenectomy.