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Objective: Published rates of complications for splenectomy are very low, however these are single institution series focused on many primary splenic conditions. Our objective is to evaluate complications following splenectomy for benign and malignant hematologic disorders to help guide decision making and informed consent for this procedure.
Methods: A review of the ACS-NSQIP data set for splenectomy performed from 2006-2009 was performed. Preoperative clinicopathologic variables and postoperative complications were evaluated. Patients included for analysis had a primary diagnosis of a benign (hemolytic anemia, thrombocytopenia) or a malignant (leukemia and lymphoma) hematologic condition. Non-elective procedures or splenectomy performed in addition to another major procedure (e.g., colectomy) were excluded.
Results: There were 4,859 splenectomy procedures collected from ACS-NSQIP data set during the time period evaluated, and 1,762 met criteria for analysis. 1,379 (78.3%) operations were for benign conditions while the remaining 383 (21.7%) were for malignant disease. Patients with benign conditions were younger, female, more commonly diabetic, had higher BMI, and were more often on steroids preoperatively. Patients with benign disease also had better overall preoperative performance status compared to patients with malignancy. Patients with benign disease more often had laparoscopic procedures (81.8% vs. 39.1%, p<0.0001).
Overall mortality at 30 days was 1.6% (n=29) and was not significantly different for malignant (2.1%) vs. benign (1.5%) disease. The overall complication rate was 13.6% and was higher for patients with malignant disease (19.6%) vs. benign disease (11.9%, p=0.0002) (Table). Infectious complications (superficial and deep SSI, UTI, sepsis, and pneumonia) predominated in patients with malignancy (16.0% vs. 9.1% for patients with benign disease, p=0.0002).
Conclusions: In this very large multi-institution data set, 30-day mortality for splenectomy for hematologic diseases is as high as 2.1% and is associated with an overall complication rate of 12% for patients with benign conditions and 20% for malignancy. Immediate infectious complications are common following splenectomy for these conditions. A multivariate analysis is underway to determine the specific variables that can account for the significant morbidity and mortality from splenectomy for hematologic disorders.
Complications from Splenectomy for Hematologic Disorders

Variable	Benign Disease n=1,379 n (%)	Malignant Disease n=383 n (%)	p-value
Overall 30-day Mortality	21 (1.5)	8 (2.1)	0.37
Overall Morbidity	164 (11.9)	75 (19.6)	0.0002
Infectious Complications	125 (9.1)	61 (16.0)	0.0002
DVT/PE	33 (2.4)	11 (2.8)	0.58
Transfusion	30 (2.2)	15 (3.9)	0.06
Reoperation	43 (3.1)	12 (3.1)	0.87
Length of Stay (median days, range)	3 (6 - 11)	5 (8 - 10)	0.0005