Introduction: Although laparoscopy has become the preferred surgical procedure for elective splenectomies, the risk factors for increased post-operative complications are not well defined. We identified the risk factors for post-operative complications for laparoscopic (LS) and open splenectomies (OS), to assess the impact of laparoscopic approach.Methods: A retrospective review of all patients that underwent an elective splenectomy for non-traumatic indications between 1/1/1997 to 1/1/2007 was performed. Patient demographics, operative time, spleen weight, length of stay (LOS), and inpatient morbidity and mortality were recorded. LS and OS were compared on an intention-to-treat basis, using t-tests. Logistic regression was used to identify independent risk factors for a complication, and the impact of the laparoscpic approach on these individual risk factors was assessed.Results: A total of 262 patients (184 OS, 78 LS) were identified, with an overall complication rate of 11%, and a mortality rate of 3%. The LS group was associated with a significant reduction in LOS, morbidity, and blood loss, but an increase in surgical time (Table 1). The conversion rate was 13%, with the splenic weight being higher in the converted cases against non-converted (487 g vs. 296 g, p<0.05).Using logistic regression on pooled complication data, age (p=.049) and BMI (p=.003) were identified as independent risk factors for post-operative complications, whereas splenic weight was not. The effect of laparoscopic approach was compared to open surgery for these established risk factors. BMI (p=0.004) remained independent risk factors for OS, but not for LS. Further analyzing the impact of BMI on surgical complications, malnutrition (BMI<18.5) was associated with the highest risk for surgical complications and LS had no beneficial effect. The MIS technique however reduced the complication rate for the normal weight group (23% for OS vs. 4% for LS, p<0.05).Conclusions: LS can decrease established risk factors for surgical complications and improve outcomes. Although larger spleens are associated with a higher conversion rate, splenic weight is not an independent risk factor for complications, and not a contraindication to the laparoscopic approach.
Patient Demographics

	OS	LS	p
BMI	25.7	26.3	NS
OR time (min)	108	147	<0.05
Blood loss (cc)	593	356	<0.05
Splenic weight	1270	320	<0.05
LOS	5.7	3.8	<0.05
Morbidity	14.7	3.9	<0.05