The Impact of Operative Approach in Elective Splenectomy: A Multivariate Analysis of Outcomes From the NSQIP Database

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Purpose:Laparoscopy is an increasingly prevalent choice for elective splenectomy but it carries an inconsistent documentation of complications. This study examines 30-day postoperative outcomes after open (OS) and laparoscopic (LS) splenectomy.Methods:Elective splenectomies were extracted from the National Surgical Quality Improvement Program database. Multivariate analysis determined factors associated with complications and an increased postoperative length of stay (LOS).Results:There were a total of 1583 splenectomies with 991 (63.0%) laparoscopic cases. On univariate analysis, the LS group had fewer major (10.6% vs. 18.8%, P<0.0001) and minor complications (2.6% vs. 7.1%, P<0.0001). Adjusting for baseline differences, LS was not associated with an increase in major complications [odds ratio (OR), 0.76; 95% confidence interval, 0.54-1.08; P=0.1255] but offered a decrease in minor complications (OR, 0.41; 95% confidence interval, 0.24-0.69; P=0.0010) coupled with a decrease in postoperative LOS of 1.89±0.30 days (P<0.0001) compared with OS.Conclusions:After accounting for comorbidities and intraoperative factors, laparoscopy remains a safe choice for elective splenectomy with fewer complications and shorter LOS.

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