Postoperative Morbidity After Splenectomy for Hematologic Diseases
Myeloid dysplasia/myelofibrosis has the highest postoperative morbidity after splenectomy among hematologic diseases, with complication rates of approximately 50% and perioperative mortality of 5-10%. 1
Evidence Analysis
The American College of Surgeons clearly identifies myeloid dysplasia/myelofibrosis as having the highest postoperative morbidity following splenectomy compared to other hematologic conditions 1. This is strongly supported by multiple research studies:
- Patients with myelofibrosis experience a 50% complication rate and 21% mortality rate post-splenectomy 2
- A 20-year study of 223 patients with myelofibrosis showed 31% morbidity and 9% mortality rates 3
- Myelofibrosis patients face increased risks of:
- Surgical site bleeding
- Thrombosis
- Subphrenic abscess
- Extreme thrombocytosis
- Infections due to functional hyposplenism 1
Comparison with Other Hematologic Conditions
When comparing postoperative morbidity rates across different hematologic conditions:
- Myeloid dysplasia/myelofibrosis: ~50% complication rate 1, 2
- Immune thrombocytopenia (ITP): ~20% complication rate 1
- Hereditary spherocytosis: <20% complication rate 4
- Sickle cell anemia and thalassemia: Lower complication rates than myelofibrosis, though they carry risks of OPSI due to functional hyposplenism 1
Risk Factors for Complications
Several factors increase the risk of complications after splenectomy:
- Splenic weight >1500g or >2000g significantly increases complication risk 2, 5
- Operative blood loss is directly correlated with postoperative complications 2
- Pre-operative thrombocytopenia in myelofibrosis patients indicates advanced disease and higher complication risk 3
- Age <50 years, normal to high platelet counts, and huge splenomegaly predict hemorrhagic or thrombotic complications 6
Clinical Implications
For patients with myeloid dysplasia/myelofibrosis requiring splenectomy:
- Consider alternative treatments when possible due to high morbidity rates 1
- Maintain platelet count below 400×10^9/L to prevent postoperative extreme thrombocytosis 1
- Implement prophylactic measures including vaccinations against encapsulated organisms and antibiotic prophylaxis 1
- Monitor closely for thrombocytosis, bleeding, infections, and hepatomegaly post-operatively 1, 3
Answer to Question
Based on the comprehensive evidence, the answer is (c) myeloid dysplasia, which demonstrates significantly higher postoperative morbidity rates compared to idiopathic thrombocytopenic purpura, hereditary spherocytosis, sickle cell anemia, and thalassemia.