Introduction: The incidence of splenic injury requiring splenectomy during mobilization of the colon varies from 2% during elective surgery to 10% for traumatic colon injuries. This retrospective study attempts to identify incremental risk factors, including surgeon-related factors, for incidental splenectomy (IS) during splenic flexure mobilization (SFM) in colorectal resections.
Methods: Using an administrative database we identified all adult general surgery patients who underwent colectomy requiring SFM from June 1, 2003 through January 1, 2006. Patients requiring splenectomy as part of an en-bloc cancer resection were excluded, as were trauma patients. Patients were divided into two groups: Group (Gp) 1 (n=6) included patients with SFM and IS, Gp 2 (n=337) included patients with SFM and no IS. The two groups were compared with univariate analysis to identify predictive risk factors for IS, using Fischer's exact test to determine statistical significance. The data are presented as means ± standard deviation.
Results: A total of 337/1112 (30%) of patients undergoing colectomy required SFM. Of these, 6/337 (1.7%) patients underwent IS. Patients in the two groups differed with respect to age, nature of the procedure (emergency vs. elective), and duration of surgery. Gp1 patients were older than those in Gp 2 (80 ± 4 vs. 62 ± 18 years, p=0.01), required more emergency procedures (4/6 vs. 44/337, p=0.04), and had longer operative time (5 ± 1 vs. 3 ± 1 hours, p=0.001). The two groups did not differ with respect to gender. Surgeons’ specialty, volume of colon resection, or experience did not affect the rate of IS. Both the major complication rate and the transfusion rate in Gp 1 was 83%. The mortality rate in Gp 1 was 50%. Length of stay was significantly longer in Gp 1 (44 ± 49 vs. 11 ± 12 days, p=0.01).
Conclusions: We conclude that IS in patients undergoing colectomy with SFM is more likely to occur in elderly patients undergoing emergency surgery, and is associated with increased transfusion requirements and a high mortality rate. Surgeon-related factors do not appear to have an impact on the rate of IS.
Table #1: Demographics

	Gp 1, (n=6)	Gp 2, (n=337)	P-value
Gender, Male:Female	5:1	170:167	Not significant (NS)
Mean Age (range), in years	80 ± 4 (77 - 86)	62 ± (9 - 103)	0.01
Mean Operative time (range), in hours	5 ± 1 (3.3 -7.3)	3 ± 1 (0.46 - 11.3)	0.001
Length of Stay (range), in days	44 ± 49 (7 - 133)	11 ± 12 (1 - 98)	0.01

Table #2: Surgeon-Related Factors

	Gp1, (n=6)	Gp2, (n=337)	P-value
Years in Practice < 10 years > 10 years	2 4	96 241	Not significant (NS)
Colorectal Volume < 10 colectomies per year > 10 colectomies per year	3 3	83 254	NS
Surgical Speciality Colorectal Surgery General Surgery Minimally Invasive Surgery Surgical Oncology Tramuma/Critical Care	2 1 0 1 2	179 66 15 59 18	NS*

*Colorectal surgery versus all other specialties.