Abstract
Background
Children who have undergone splenectomy may develop impaired immunologic function
and heightened risk of overwhelming postsplenectomy infection. We sought to define
the long-term rate of and risk factors for postsplenectomy sepsis.
Methods
We leveraged the Military Health System Data Repository, a nationally representative
claims database including >3 million children registered as dependents of members of the United States Armed
Services (2005–2014). Inclusion criterion was splenectomy at age 18 years or prior.
The primary outcome was hospitalization for sepsis.
Results
Among 195 children who underwent splenectomy, 7% (n = 13) were hospitalized with sepsis, with an incidence of 1.8 (95% CI = 1.0-3.1)
events per 100 person-years. The median time to sepsis was 224 days (IQR = 109–606)
and 38% (5/13) of events occurred within the first postsplenectomy year. The postsplenectomy
mortality rate was 1% (n = 3). After adjusting for underlying diagnosis, older age at splenectomy (HR = 0.90
per year, 95% CI = 0.81–0.99) was associated with decreased hazard of sepsis.
Conclusions
In a contemporary national cohort, the prevalence of postsplenectomy sepsis was 7%
(1.8 events per 100 person-years). Although most presented during the first year after
splenectomy, many (62%) sepsis events occurred later, suggesting that postsplenectomy
immunologic dysfunction persists beyond one year. The immunologic consequences of
asplenia must continue to be acknowledged, as postsplenectomy sepsis remains a serious
concern.
Type of Study
Prognosis study.
Level of Evidence
Level III.
Key words
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Article info
Publication history
Published online: July 17, 2018
Accepted:
June 15,
2018
Received in revised form:
June 13,
2018
Received:
April 23,
2018
Footnotes
☆Presentation information: Podium presentation at the 2017 American Academy of Pediatrics Annual Meeting, Section on Surgery (Chicago, IL).
☆☆Disclaimers: The opinions and assertions expressed herein are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.
Identification
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