From the Guidelines
The answer is (d) sickle cell anemia. Postoperative morbidity after splenectomy is highest in patients with sickle cell anemia compared to other hematologic diseases. This increased risk is primarily due to the underlying pathophysiology of sickle cell disease. Patients with sickle cell anemia are prone to vaso-occlusive crises, acute chest syndrome, and other complications that can be triggered by surgical stress, anesthesia, and the physiological changes that occur during and after surgery. Although the provided study 1 discusses the risks and challenges associated with splenectomy in patients with immune thrombocytopenia (ITP), it highlights the general risks of splenectomy, including surgical complications and long-term risks such as infections and thromboembolism. However, it does not specifically compare the postoperative morbidity of splenectomy across different hematologic diseases.
Key Considerations
- Patients with sickle cell anemia often have pre-existing organ damage from their chronic disease, including cardiac, pulmonary, and renal dysfunction, which further increases their surgical risk.
- Preoperative optimization with hydration, transfusion to reduce the percentage of sickle hemoglobin, careful anesthetic management, and vigilant postoperative care are essential to reduce complications in these patients.
- In contrast, patients with conditions like ITP, hereditary spherocytosis, myeloid dysplasia, and thalassemia generally have lower rates of postoperative complications following splenectomy, though each has its own specific considerations.
- The study 1 notes that splenectomy is associated with serious short- and long-term risks, including infections, thromboembolism, and possibly an increased incidence of malignancy, which results in an increased risk of death that persists for >10 years after surgery.
Risks and Complications
- The hypoxia, acidosis, and dehydration that may accompany surgery can precipitate sickling of red blood cells, leading to microvascular occlusion and tissue ischemia.
- Patients who undergo splenectomy need lifelong management to prevent sepsis, such as vaccinations and prophylactic antibiotics, as well as surveillance for relapse, as highlighted in the study 1.
From the Research
Postoperative Morbidity after Splenectomy
The question of which hematologic disease has the highest postoperative morbidity after splenectomy can be addressed by examining the provided evidence.
- The study 2 found that patients with myelofibrosis had the highest incidence of complications (50%) and the highest postoperative mortality (21%; p = 0.04) after splenectomy.
- However, myelofibrosis is not among the options listed in the question.
- Another study 3 reported that patients treated for malignant disease had a higher rate of overall complications (27.2%) compared with patients treated for benign disease (14.1%) (P < .001).
- The options provided include both benign and malignant diseases, but none of the studies directly compare the postoperative morbidity of the specific diseases listed in the question.
- A study 4 mentions that splenectomy is therapeutic for various hematologic disorders, including red blood cell disorders and thrombocytopenic disorders, but does not provide specific data on postoperative morbidity.
- Another study 5 found that among malignant cases, only preoperative thrombocytopenia predicted death, while for benign cases, increasing age was associated with inferior survival.
- A study 6 reports on the clinical indications and surgical technique for splenectomy in hematologic diseases, but does not provide a direct comparison of postoperative morbidity among the listed diseases.
- Based on the available evidence, it is not possible to determine which of the listed diseases (idiopathic thrombocytopenic purpura, hereditary spherocytosis, myeloid dysplasia, sickle cell anemia, or thalassemia) has the highest postoperative morbidity after splenectomy, as the studies do not provide a direct comparison of these specific diseases.