Journal of Pediatric Surgery 51 (2016) 122127

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Journal of Pediatric Surgery

journal homepage: www.elsevier.com/locate/jpedsurg

Hematologic outcomes after total splenectomy and partial splenectomy

for congenital hemolytic anemia,
Brian R. Englum a,, Jennifer Rothman a, Sarah Leonard a, Audra Reiter a, Courtney Thornburg a, Mary Brindle b,
Nicola Wright b, Matthew M. Heeney c, C. Jason Smithers c, Rebeccah L. Brown d, Theodosia Kalfa d,
Jacob C. Langer e, Michaela Cada e, Keith T. Oldham f, J. Paul Scott f, Shawn D.St. Peter g, Mukta Sharma g,
Andrew M. Davidoff h, Kerri Nottage h, Kathryn Bernabe i, David B. Wilson i, Sanjeev Dutta j, Bertil Glader j,
Shelley E. Crary k, Melvin S. Dassinger k, Levette Dunbar l, Saleem Islam l, Manjusha Kumar m,
Fred Rescorla m, Steve Bruch n, Andrew Campbell n, Mary Austin o, Robert Sidonio p,
Martin L. Blakely q, Henry E. Rice a, on behalf of the Splenectomy in Congenital Hemolytic Anemia (SICHA) Consortium 1
a

Duke University Medical Center, Durham, NC, United States

Calgary Children's Hospital, Calgary, AB, Canada
c
Boston Children's Hospital, Boston, MA, United States
d
Cincinnati Children's Medical Center, Cincinnati, OH, United States
e
Hospital for Sick Children, Toronto, ON, Canada
f
Medical College of Wisconsin, Milwaukee, WI, United States
g
Children's Mercy Hospital, Kansas City, MO, United States
h
St. Jude Children's Research Hospital, Memphis, TN, United States
i
St. Louis Children's Hospital, St. Louis, MO, United States
j
Stanford University, Palo Alto, CA, United States
k
University of Arkansas, Little Rock, AR, United States
l
University of Florida, Gainesville, FL, United States
m
University of Indiana, Indianapolis, IN, United States
n
University of Michigan, Ann Arbor, MI, United States
o
University of Texas/MD Anderson Cancer Center, Houston, TX, United States
p
Emory University, Atlanta, GA, United States
q
Vanderbilt University Medical Center, Nashville, TN, United States
b

a r t i c l e

i n f o

Article history:
Received 30 September 2015
Accepted 7 October 2015
Key words:
Congenital hemolytic anemia
Splenectomy
Hematologic outcomes
Surgical technique

a b s t r a c t
Purpose: The purpose of this study was to dene the hematologic response to total splenectomy (TS) or partial
splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD).
Methods: The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic
outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling,
we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin.
We also compared laparoscopic to open splenectomy.
Results: The analysis included 130 children, with 62.3% (n = 81) undergoing TS. For children with HS, all
hematologic measures improved after TS, including a 4.1 g/dl increase in hemoglobin. Hematologic parameters
also improved after PS, although the response was less robust (hemoglobin increase 2.4 g/dl, p b 0.001).
For children with SCD, there was no change in hemoglobin. Laparoscopy was not associated with differences in
hematologic outcomes compared to open. TS and laparoscopy were associated with shorter length of stay.
Conclusion: Children with HS have an excellent hematologic response after TS or PS, although the hematologic
response is more robust following TS. Children with SCD have smaller changes in their hematologic parameters.
These data offer guidance to families and clinicians considering TS or PS.
2016 Elsevier Inc. All rights reserved.

Level of Evidence: II.

IRB approval: Duke Medicine IRB for Clinical Investigations; IRB ID: Pro00020000; Approval Date: 10/22/2009.
Corresponding author at: Duke University Medical Center, DUMC, Box #3443, Durham, NC 27710-0001, United States. Tel.: +1 317 213 2360.
1
A complete list of the members of the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium appears in the Acknowledgments.
http://dx.doi.org/10.1016/j.jpedsurg.2015.10.028
0022-3468/ 2016 Elsevier Inc. All rights reserved.

B.R. Englum et al. / Journal of Pediatric Surgery 51 (2016) 122127

Splenectomy can control select clinical symptoms in severely

affected children with congenital hemolytic anemias (CHA) such as
hereditary spherocytosis (HS) or sickle cell disease (SCD) [15].
However, the risks associated with total splenectomy (TS) such as
postsplenectomy sepsis and venous thromboembolism remain major
concerns for patients and clinicians [6]. Advances with splenectomy
for CHA in the last 2 decades have included laparoscopy [4,79] and partial splenectomy (PS) [2,3,5,10]. Although the advantages of laparoscopy are becoming more clear, studying the impact of partial splenectomy
is limited by small sample size, rare clinical events, lack of comparison
groups, narrowly focused patient populations, and use of nonstandardized data [5,11]. To address this gap in understanding of splenectomy,
we formed a clinical research consortium entitled Splenectomy in
Congenital Hemolytic Anemia (SICHA), composed of pediatric surgeons
and hematologists at 16 sites in North America [12].
With no reports focused on a direct comparison of TS vs. PS, the goal
of the current study was to examine the differences between these
procedures in a head-to-head evaluation. Our consortium has operated
an observational, multicenter registry for children with CHA undergoing
different types of splenectomy, and has recently demonstrated
excellent clinical outcomes and low risk of adverse events in children
undergoing TS or PS [3]. However, the low rate of clinical events limits
the ability to identify subtle but important differences between
procedures given multiple clinical confounders; therefore, the current
report uses random effects mixed modeling to account for confounding
variables in this heterogeneous population. We hypothesized that TS
and PS would not result in signicantly different hematologic outcomes
in children with HS or SCD, and used a random effects model to compare
outcomes of TS and PS in children with HS and SCD. We also examined
hematologic responses over time, and compared outcomes between
laparoscopic and open procedures.
1. Methods
1.1. SICHA
The SICHA clinical research consortium was established to provide a
research infrastructure for high-quality, standardized data collection to
support the study of children with CHA. After input from multiple stakeholders, a data dictionary, data collection system, and prospective study
protocol were implemented to develop a Web-linked, observational,
prospective patient registry collecting high-delity outcomes of children with CHA undergoing different types of splenectomy. The details
of registry operations have been previously published [3,12].
1.2. Study population
Children aged 217 years with HS or SCD undergoing PS or TS from
2005 to 2014 at one of the 16 SICHA sites were reviewed for the study
(n = 130). Patients with CHA classied as other thalassemia or
other congenital hemolytic anemia were excluded. As an observational registry, no care was dictated by this study, and the decision for TS or
PS was left to the discretion of the family and primary clinicians. Patients with splenectomy for trauma or idiopathic thrombocytopenia
purpura were not enrolled. Institutional Review Board approval was
obtained from each site, and informed consent was required.
1.3. Study design
We analyzed demographic and disease characteristics, operative
techniques, and hematologic outcomes, with hematologic variables
collected at baseline and 4, 24, and 52 weeks after surgery. Our
main comparison groups were TS vs. PS. Patients converted from PS
to TS as well as from laparoscopic to open approach were analyzed in
an intention to treat manner. A sensitivity analysis examining PS
converted to TS as TS was also performed. Other variables of interest

123

included gender, race/ethnicity, laparoscopic vs. open technique and

diagnosis [2].
1.4. Outcomes
The primary hematologic outcomes were hemoglobin, reticulocyte
count, and bilirubin. Secondary outcomes included remnant splenic volume (estimated by surgeon intraoperatively and by follow-up ultrasound), estimated blood loss, length of stay (LOS), postoperative and
long-term blood transfusion requirements, postsplenectomy sepsis,
and death. All variables have been previously dened [3].
1.5. Statistical analysis
We expressed outcomes using count and percentages for categorical
variables and median and interquartile range for continuous variables.
To determine signicant differences between cohorts, Pearson's chisquared or Fisher's exact test were used as appropriate for categorical
data and the MannWhitney U test was used for continuous data.
To account for confounding factors and better understand expected
hematologic outcomes following different procedures, a random effects
mixed model was applied to hematologic outcomes. This allowed us to
use multiple time points for each patient, increasing the power to identify associations between case characteristics and hematologic changes
[13]. The random effects mixed model included the following variables:
gender, race/ethnicity, laparoscopic vs. open technique, PS vs TS, diagnosis, baseline laboratory measures, and weeks from surgery. In addition to the factors above, the association of the hematologic outcomes
with weeks after surgery was examined to evaluate for temporal trends
in the hematologic response. Results of the mixed model are described
as the point estimate in the difference between 2 groups and the 95%
condence interval (CI) around that estimate. It was determined a priori
to include an interaction term between diagnosis and response to
surgery. If a signicant interaction existed, these populations would be
analyzed separately. p-Values b0.05 were considered statistically significant, with type I error controlled at the level of comparison. All statistical analyses were performed using R (v. 3.02; R Foundation for
Statistical Computing, Vienna, Austria).
2. Results
2.1. Patient characteristics
Of 130 eligible cases in the SICHA registry 120 children (92%) had 4week follow-up and 81 children (62%) had 1 year follow-up. Most patients in all groups had follow-up through 1 year, with mean followup (standard deviation) for each group of interest as follows: total splenectomy, 34 (21) weeks; partial splenectomy, 42 (18) weeks; open
splenectomy, 47 (13 weeks); and laparoscopic splenectomy, 33 (21)
weeks. The majority of children underwent TS (62%), with the remaining children undergoing PS. SCD made up 53% of children, while 47%
had HS (Table 1). The use of PS did not differ by diagnosis; however, patients with splenic sequestration as an indication for surgery were more
likely to undergo TS.
2.2. Hematologic outcomes
Unadjusted hematologic outcomes are described in Figs. 1 and 2.
Using adjusted mixed modelling analysis, we found differences in the
hematologic response to surgery between SCD and HS (interaction
p b 0.001 for all parameters) and analyzed these groups separately. Children with HS experienced increased hemoglobin (4.1 g/dl; 95% CI:
3.15.1 g/dl; p b 0.001), decreased reticulocytes (8.3%; 5.2%11.4%;
p b 0.001), and decreased bilirubin (1.9 mg/dl; 0.53.4 mg/dl; p =
0.01) after splenectomy (Fig. 3). Children with HS undergoing laparoscopic surgery (TS or PS) trended toward a smaller increase in

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B.R. Englum et al. / Journal of Pediatric Surgery 51 (2016) 122127

Table 1
Demographic, disease, and operative characteristics.
Variable

Overall

Total
splenectomy

Partial
splenectomy

N
Demographics
Gender
Male
Female
Race/Ethnicity
White
Black
Hispanic
Other
Diagnosis
Hereditary spherocytosis
Sickle cell disease
Indication for surgery
Splenic sequestration
Transfusion dependence
Splenomegaly
Hypersplenism
Aplastic crisis or anemia
Poor growth
Operative characteristics
Partial converted to total
Initial approach
Open
Laparoscopic
Laparoscopic converted
to open

130

81 (62.3%)

49 (37.7%)

67 (51.5%)
63 (48.5%)

42 (51.9%)
39 (48.1%)

25 (51%)
24 (49%)

52 (40%)
69 (53.1%)
7 (5.4%)
2 (1.5%)

26 (32.1%)
50 (61.7%)
4 (4.9%)
1 (1.2%)

26 (53.1%)
19 (38.8%)
3 (6.1%)
1 (2%)

61 (46.9%)
69 (53.1%)

33 (40.7%)
48 (59.3%)

28 (57.1%)
21 (42.9%)

74 (56.9%)
28 (21.5%)
22 (16.9%)
4 (3.1%)
7 (5.4%)
6 (4.6%)

54 (66.7%)
19 (23.5%)
9 (11.1%)
2 (2.5%)
4 (4.9%)
6 (7.4%)

20 (40.8%)
9 (18.4%)
13 (26.5%)
2 (4.1%)
3 (6.1%)
0 (0%)

p-Value

0.93

0.05

0.07

2 (4.2%)

0 (0%)

b0.01
0.64
0.04
0.63
0.99
0.08

2 (4.2%)
b0.001

37 (28.5%)
93 (71.5%)
9 (9.9%)

9 (11.1%)
72 (88.9%)
3 (4.2%)

28 (57.1%)
21 (42.9%)
6 (30.0%)

b0.01

hemoglobin compared to open surgery (p = 0.08), increasing their hemoglobin by only 3.3 g/dl. Children with HS who underwent PS had a
signicantly smaller hemoglobin rise compared to TS (p b 0.001), increasing by only 2.4 g/dl postoperatively. When examining the hemoglobin response over time, we found no changes through 1 year of
follow-up, indicating that after the initial increase associated with surgery values remained steady (p = 0.10).
In HS, the change in reticulocyte count after surgery was not associated with either PS vs. TS or laparoscopic vs. open technique, meaning
that the N8% decrease in reticulocytes was not signicantly different
among any subgroup. After the initial 8.3% drop in reticulocytes, there
was evidence of a rebound of 2.4% (0.7%4.3%; p = 0.01) over the rst
6 months; however, reticulocytes stabilized from 6 months to 1 year
(p = 0.87). Similar to the decrease in reticulocytes, the change in bilirubin was not associated with splenectomy type or surgical technique in
HS. These changes showed no trends over time (p = 0.34) through
1 year. No HS patients converted from partial to total splenectomy, so
no sensitivity analysis was required.
In children with SCD, there was no signicant increase in hemoglobin
(0.1 g/dl; 0.8 to 1.9 g/dl; p = 0.77) after surgery and no differences
when comparing PS to TS or laparoscopy to open splenectomy. Reticulocytes did decrease by 4.2% (0.8%7.6%; p = 0.02). Use of laparoscopy was
not associated with a difference in reticulocytes compared to open
surgery; however, PS was associated with a smaller reticulocyte improvement by 3.4% (0.3%6.5%; p = 0.03) compared to TS. In addition,
there was a small decrease in bilirubin by 1.0 mg/dl (0.31.7 mg/dl;
p = 0.01) after surgery. Laparoscopy showed no difference, although
PS resulted in a smaller bilirubin decrease by 0.8 mg/dl (0.11.4 mg/dl;
p = 0.03) compared to TS. No changes were found over time. In a sensitivity analysis grouping children by procedure performed rather than intention to treat, the same trends were seen; however, the difference in
reticulocytes was not statistically signicant (p = 0.07), indicating that
these results may be sensitive to the rate of conversion from PS to TS.
2.3. Secondary outcomes
PS appeared to have greater estimated blood loss than TS (28% with
EBL 100 ml vs. 14%), but perioperative transfusions were similar (6.2%

Fig. 1. Unadjusted hematologic outcomes after partial or total splenectomy in children

with hereditary spherocytosis. Data represent hemoglobin (A), reticulocyte count (B),
and serum bilirubin (C), at baseline, 4 weeks, 24 weeks, and 52 weeks. Circles represent
mean and error bars represent standard error. Because of limited data points available at
52 weeks in children with HS undergoing total splenectomy, data are not displayed.

vs. 3.8%; p = 0.67) (Table 2). LOS was 1.5 days longer in the PS group
(3.5 vs. 2 days, p b 0.001). Long-term transfusion requirements through
1 year were similar between PS and TS (2.1% vs. 5.6%; p = 0.65). By
surgeon estimate, patients undergoing PS were left with a median
splenic volume of 15% of original (IQR: 10%15%), with two children
(4.2%) converted from PS to TS. PS was also less likely to be done
laparoscopic (43% vs. 89%, p b 0.001) and more likely to be converted
to open if started laparoscopic compared to TS (30% vs. 4%, p =
0.003). Although there were no deaths in this cohort through 1 year of
follow-up, 3 children (4.2%) undergoing total splenectomy experienced
postsplenectomy sepsis compared to 0 children undergoing partial
splenectomy (p = 0.28).
Laparoscopic splenectomy had higher blood loss than open splenectomy (24% vs. 5.8% of children losing 100 ml of blood), but perioperative transfusions showed no difference with 5.6% vs. 2.8% requiring

B.R. Englum et al. / Journal of Pediatric Surgery 51 (2016) 122127

Fig. 2. Unadjusted hematologic outcomes after partial or total splenectomy in children

with sickle cell disease. Data represent hemoglobin (A), reticulocyte count (B), and
serum bilirubin (C), at baseline, 4 weeks, 24 weeks, and 52 weeks. Circles represent
mean and error bars represent standard error.

transfusion in laparoscopic and open approaches, respectively (p =

0.67; Table 3). The LOS was longer with use of open technique
(3 days) compared to laparoscopy (2 days; p = 0.002). With a median
of 15% of retained spleen, there were no differences between remnant
volume in laparoscopy vs open technique (p = 0.38). These results
were conrmed in 4, 24, and 52 week assessments of splenic remnant
by ultrasound.
3. Discussion
The outcomes of both total and partial splenectomy remain incompletely dened, with most prior studies limited by small samples or
lack of comparison groups [12]. Our consortium has developed a multicenter patient registry to better understand the outcomes of these procedures, and we have previously demonstrated excellent clinical
outcomes after all types of splenectomy in these children [3]. However,

125

the low rates of clinical events allow limited sensitivity to identify subtle
differences between procedures; therefore, we used random effects
mixed models to examine these differences and better understand expected hematologic outcomes from various procedures and diagnoses.
All types of splenectomy improve hemoglobin, reticulocyte, and bilirubin measures in children with HS. The hematologic outcomes from
the mixed modeling analysis (Fig. 3) correlate well with those displayed
in the unadjusted analysis (Figs. 1 and 2). Our current ndings conrm
most prior studies examining PS for children with HS, which have
shown good clinical and hematologic responses to surgery, although
the hematologic response to TS is more robust than PS [2,5,10,1416].
This difference between TS and PS is not unexpected given the remaining splenic remnant effect on hemolysis following PS. In addition, both
adjusted and unadjusted analyses demonstrated initial postoperative
improvements that remained stable over time. The exception was reticulocyte count which demonstrated a rebound after initial improvement
in HS; however, the 6-month and 1-year values continued to be lower
than baseline.
Although no signicant difference was found in postsplenectomy
sepsis, the higher rate of this complication following TS underlines the
complexity of the decision to undergo PS or TS. The most appropriate
procedure for a given child depends on many variables, such as age, disease severity, genotype, risk of adverse events, and long-term hematologic control, and not all were addressed in this study. The decision
between TS and PS is dependent on clinician and family preferences,
taking into account all expected risks and benets. Our current report
provides estimates of hematologic response following TS or PS, which
should help all stakeholders through this decision-making process.
For children with SCD, our ndings conrm most studies which suggest that hemoglobin levels do not change after TS or PS [12]. However
these ndings are likely confounded by articially elevated hemoglobin
preoperatively because of the common practice of chronic transfusions
following sequestration events in very young children with SCD. While
reticulocyte count and bilirubin may be more sensitive measures for hematologic improvement in SCD, the small differences that we found in
these measures support previous studies in suggesting that splenectomy in SCD should focus on outcomes such as quality of life or adverse
events rather than hematologic parameters. We and others have previously conrmed control of important select clinical symptoms in these
children with regard to transfusion dependence and sequestration
following either TS or PS, which is a major goal for both families and
clinicians caring for these children [3,12,17].
Numerous previous studies have compared laparoscopic to open
splenectomy in children, nding advantages in postoperative pain control and decreased length of stay (LOS) for children undergoing laparoscopy [4,79]. The single study comparing hematologic outcomes for
laparoscopic vs. open PS showed similar postoperative hemoglobin
but less favorable results in reticulocytes [11]. This prior study also demonstrated a larger splenic remnant in laparoscopy vs open splenectomy,
raising concerns that hematologic benets may depend on the amount
of spleen resected, and that extensive resection may not be as easily
achieved in laparoscopic technique. Our current study offers reassurance that the hematologic outcomes following laparoscopy for TS or
PS are similar to an open approach, and that the retained spleen size is
not different between approaches for children undergoing PS. We did
conrm the longer LOS for open splenectomy compared to laparoscopy
as previously reported [4]. PS has a low but real risk of conversion to
total splenectomy estimated at 4%. In addition, this study demonstrates
a signicantly higher conversion from laparoscopic to open surgery in
PS compared to TS (30% vs. 4%), which surgeons and families need to
understand when considering these procedures.
This study has the advantage of generalizable results due its
prospective and multi-institutional design. Because random effects
models allow the use of multiple data points per patient [13], this
analytic approach can identify differences among subgroups, as we
used an average of 250 data points per hematologic outcome and

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B.R. Englum et al. / Journal of Pediatric Surgery 51 (2016) 122127

Fig. 3. Postsplenectomy changes in hematologic parameters for children with congenital hemolytic anemias. Results represent differences in postoperative hematologic values at 4, 24, and
52 weeks (versus baseline), laparoscopic (versus open) splenectomy, and partial (versus total) splenectomy as indicated. Results produced from random-effects mixed modeling including
the following covariates: gender, race/ethnicity, laparoscopic vs. open technique, partial vs. total splenectomy. Hereditary spherocytosis and sickle cell disease were analyzed separately.
Blue squares represent point estimates and black lines represent 95% condence intervals. Results are additive such that estimating the change in postoperative hemoglobin after laparoscopic partial splenectomy, the point estimates for postoperative, laparoscopy, and partial splenectomy would need to be added. For example, the postoperative hemoglobin increase in HS
is estimated at 4.1 g/dl in open, total splenectomy. This estimate is decreased by 1.7 g/dl in partial splenectomy compared to total splenectomy (estimate displayed) indicating that the
expected postoperative hemoglobin in partial splenectomy would only be 2.4 g/dl (equal to 4.11.7; not displayed).

accounted for important confounding factors. In a therapeutic area that

is limited by sample size and rare clinical events, this tool provides
sensitive assessment of differences that may exist between patient
groups and procedure types.
Despite the use of a prospective, multi-institutional database and
multivariable analysis to better dene expected hematologic outcomes
of TS or PS, our report remains limited by the inherent aws of observational research and small sample size. The conrmatory nature of our
ndings to previous studies adds to their validity, but additional unmeasured confounders that impact the decision to perform TS or PS may
bias our results. Although mixed modeling allows robust treatment
of missing or incomplete data among other advantages previously
mentioned, this analytic technique increases the uncertainty around
estimates making real differences more difcult to detect. Mixed modeling results can also be challenging to interpret as they rely on comparisons rather than the more intuitive absolute values. Finally, results were
limited by patients missing or not yet achieving 1-year follow-up and
results being more heavily weighted by earlier time points. The consortium has added follow-up through 5 years to the protocol and hopes
that continued contact with these patient and the longer follow-up period will improve future studies.
4. Conclusions
Children with HS undergoing either TS or PS can expect improvements in all hematologic outcomes that are durable through one year,
with TS providing a more robust response compared to PS. For children

with SCD, hematologic parameters showed lesser changes, although

previous reports demonstrate acceptable control of select clinical symptoms after TS or PS. We did not nd any difference in splenic remnant
volumes or hematologic outcomes after laparoscopic vs. open surgery.
These results suggest that total splenectomy may need stronger consideration in children with the most severe hemolytic disorders. Future research will need to examine these outcomes in the context of clinical
benets for children with different diseases.
Acknowledgments
In addition to the authors, the SICHA consortium collaborators include:
Brittany Herzberg, Jeffrey M. Ferranti, Soa Mouttalib, Meredith Nahm,
Rachel Richesson, Denise C. Snyder. We thank Terri Ainsworth,
Mark Bettger, Ceci Chamorro, Phyllis Kennel, Justin Levens, Joan Wilson
and the Duke Ofce of Clinical Research (DOCR) their assistance. The
DOCR is supported by the Duke School of Medicine, made possible through
CTSA Grant Number UL1TR001117 from the National Center for Advancing
Translational Sciences (NCATS), a component of the National Institutes of
Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely
the responsibility of the authors and do not represent the ofcial view of
NCATS or NIH. This work was supported in part by the Duke University
Ofce of Clinical Research and the Duke School of Medicine, made possible
through Clinical and Translational Science Awards Grant Number
UL1TR001117 from the National Center for Advancing Translational
Sciences (NCATS), a component of the National Institutes of Health (NIH)
and NIH Roadmap for Medical Research.

Table 2
Secondary outcomes total vs. partial splenectomy.
Variable

Overall

Total splenectomy

Partial splenectomy

N
Estimated blood loss (ml)
Estimated blood loss
b30 ml
3099 ml
100199 ml
200 ml
Perioperative blood transfusion
Splenic volume retained, surgeon estimate (%)
Length of stay (days)
Long-term transfusion (through 1 year)
Sepsis (through 1 year)

130
15 (10, 50)

81 (62.3%)
15 (10, 30)

49 (37.7%)
25 (10, 100)

81 (65.3%)
19 (15.3%)
11 (8.9%)
13 (10.5%)
6 (4.8%)
0 (0, 10)
3 (2, 4)
5 (4.2%)
3 (2.5%)

57 (74%)
9 (11.7%)
6 (7.8%)
5 (6.5%)
3 (3.8%)
0 (0,0)
2 (1,3)
4 (5.6%)
3 (4.2%)

24 (51.1%)
10 (21.3%)
5 (10.6%)
8 (17%)
3 (6.2%)
15 (10,15)
3.5 (3,4)
1 (2.1%)
0 (0%)

Continuous data represented by median and interquartile range (IQR).

p-Value
0.03
0.05

0.67
b0.001
b0.001
0.65
0.27

B.R. Englum et al. / Journal of Pediatric Surgery 51 (2016) 122127

127

Table 3
Secondary outcomes laparoscopic vs. open splenectomy.
Variable

Overall

Open splenectomy

Laparoscopic splenectomy

N
Estimated blood loss (ml)
Estimated blood loss
b30 ml
3099 ml
100199 ml
200 ml
Perioperative blood transfusion
Splenic volume retained, surgeon estimate (%)
Length of stay (days)
Splenic volume retained, 4 weeks (%)
Splenic volume retained, 24 weeks (%)
Splenic volume retained, 52 weeks (%)
Long-term transfusion (through 1 year)

130
15 (10, 50)

37 (28.5%)
10 (10, 12.5)

93 (71.5%)
20 (10, 75)

81 (65.3%)
19 (15.3%)
11 (8.9%)
13 (10.5%)
6 (4.8%)
15 (10, 15)
3 (2, 4)
16 (10, 22)
15 (11, 27)
17 (10, 29)
5 (4.2%)

30 (85.7%)
3 (8.6%)
1 (2.9%)
1 (2.9%)
1 (2.8%)
15 (10, 20)
3 (3, 4)
16 (10, 25)
15 (8, 26)
22 (9, 31)
1 (2.7%)

51 (57.3%)
16 (18%)
10 (11.2%)
12 (13.5%)
5 (5.6%)
15 (10, 15)
2 (1, 4)
15 (11, 19)
15 (13, 24)
12 (12, 12)
4 (4.8%)

p-Value
b0.01
0.03

0.67
0.38
b0.01
0.78
0.78
0.77
0.99

Continuous data represented by median and interquartile range (IQR). Patients with total splenectomies were excluded from analysis on retained splenic volume.

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