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DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?

Year 2020, Volume: 22 Issue: 2, 159 - 162, 31.08.2020

Abstract

Objective: Although many complications may occur after splenectomy, post-splenectomy infection is one of the most frightening complications. Many prophylaxis methods have been used for this condition with very high rates of mortality and morbidity. In this study, we aimed to examine post-splenectomy infectious complications, in the cases in which all the measures were taken.
Material and Methods: Thirty-two patients who underwent emergency splenectomy were included in the study. Patients were given a sick leave of 20 days on isolated spleen trauma and at least 20 days for multitrauma patients. It was observed that some of the patients had started to physically heavy work due to socioeconomic reasons despite the sick leave report. A comparison was performed between the patients who completed 20 days of rest (19 cases) (Group-1) and the patients who started to work after resting time of less than 20 days (Group-2), in terms of the frequency of postoperative infection.
Results: In Group-1, only 1 case had a simple infection that could be taken under control with a simple antibiotic, while in Group 2, in 3 patients incision site infection, in 2 patients severe atypical pneumonia requiring hospitalization and in 1 patient severe viral gastroenteritis requiring daily hospitalization were observed. Although there is an insufficient number of patients in the groups, there is a statistically significant difference in terms of the frequency of infection between the groups (p<0.05).
Conclusion: Especially in the regions with low socio-economic status, sick leaves could not be used properly. This study, showed that dehydration and malnutrition, which may be secondary to heavy work, contribute to the development of infection by suppressing the immune system, in addition to the defect caused by major surgical intervention and splenectomy in the immune system, resulting in the high frequency of infection.

References

  • 1. Weledji, Elroy P. Benefits and risks of splenectomy. Int J Surg. 2014;12(2):113-9.
  • 2. King H. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136:239-42.
  • 3. Traub A, Giebink GS, Smith C, Kuni CC, Brekke ML, Edlund D et al. Splenic reticuloendothelial function after splenectomy, spleen repair and spleen autotransplantation. N Engl J Med. 1987;317(25):1559-64.
  • 4. Rosse WF. The spleen as a filter. N Engl J Med. 1987;17(11):704-6.
  • 5. Hosea SW, Brown EJ, Hamburger MI, Frank MM. Opsonic requirements for intravascular clearance after splenectomy. N Engl J Med. 1981;304(5):245-50.
  • 6. Thomsen RW, Schoonen WM, Farkas DK, Riis A, Jacobsen J, Fryzek JP et al. Risk for hospital contact with infection in patients with splenectomy: a population-based cohort study. Ann Intern Med. 2009;151(8):546-55.
  • 7. Shute PG. Splenectomy and susceptibility to malaria and babesiae infection. Br Med J. 1975;1(5956):516.
  • 8. Teo KG, Anavekar NS, Yazdabadi A, Ricketts S. Asplenic fulminant sepsis secondary to a dog bite complicated by toxic epidermal necrolysis/Stevemse Johnson syndrome. N Z Med J. 2012;125(1358):74-7.
  • 9. Barmparas G, Lamb AW, Lee D, Nguyen B, Eng J, Bloom MB et al. Postoperative infection risk after splenectomy: A prospective cohort study. Int J Surg. 2015;17:10-4.
  • 10. Hansen K, Singer DB. Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Dev Pathol. 2001;4(2):105-21.
  • 11. Dragomir M, Petrescu DGE, Manga GE, Călin GA, Vasilescu C. Patients After Splenectomy: Old risks and new perspectives. Chirurgia (Bucur). 2016;111(5):393-9.
  • 12. Sinwar PD. Overwhelming post splenectomy infection syndrome-review study. Int J Surg. 2014;12(12):1314-6.
  • 13. Skattum J, Naess PA, Gaarder C. Non-operative management and immune function after splenic injury. Br J Surg. 2012;99 Suppl 1:59-65.
  • 14. Bisharat N, Omari H, Lavi I, Raz R. Risk of infection and death among post-splenectomy patients. J Infect. 2001;43(3):182-6.
  • 15. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M et al. 2013 IDSA clinical practice guideline fo vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):309-18.
  • 16. Schwarzmann SW, Adler JL, Sullivan RJJ, Marine WM. Bacterial pneumonia during the Hong Kong influenza epidemic of 1968-1969. Arch Intern Med. 1971;127(6):1037-41.
  • 17. Wong KK, Jain S, Blanton L, Dhara R, Brammer L, Fry AM, Finelli L. Influenza-associated pediatric deaths in the United States, 2004-2012. Pediatrics. 2013;132(5):796-804.

Post-Splenektomi Enfeksiyon Gelişiminde İstirahat Süresinin Önemi Var Mı?

Year 2020, Volume: 22 Issue: 2, 159 - 162, 31.08.2020

Abstract

Amaç: Travmaya sekonder gerçekleştirilen splenektomiler sonrası birçok komplikasyon gelişebilmekle beraber en korkulan komplikasyonlardan biri erken enfeksiyonlardır. Morbidite ve mortalitesi son derece yüksek olan bu komplikasyondan korunmak için aşılama dahil birçok profilaksi metodu kullanılmaktadır. Bu çalışmada tüm önlemler alınmış bulunan olgularda, bedenen aktif-ağır çalışmaya başlamanın post-splenektomi enfeksiyöz komplikasyonlara etkisini incelemeyi hedefledik.
Gereç ve Yöntemler: Acil splenektomi yapılan 32 hasta çalışmaya dahil edildi, izole dalak travması sonucu opere edilen hastalara 20 gün, multitravma ile birlikteliği bulunan dalak yaralanması sonucu opere edilen hastalara ise hastanın genel durumuna göre en az 20 gün istirahat raporu verildi. Taburculuk sonrası postoperatif 10, 15 ve 30 uncu günlerde kontrole çağırılan hastaların bazılarının rapora rağmen sosyoekonomik sebeplerden ağır fiziksel çalışmaya başladığı gözlendi. Yirmi gün istirahatini tamamlamış olgularla (19 olgu) (Grup-1), 20 günden daha az istirahat süresi ile çalışmaya başlayan hastalar arasında (13 olgu) (Grup-2) postoperatif enfeksiyon sıklığı açısından karşılaştırma yapıldı.
Bulgular: Grup-1 de yalnız 1 olguda insizyon hattında, basit antibiyotikle kontrol altına alınabilen basit enfeksiyon gözlenirken, Grup 2 de 3 olguda kesi yeri enfeksiyonu, 2 olguda hastaneye yatış gerektiren ciddi atipik pneumoni, 1 olguda ise günübirlik yatış gerektiren ciddi viral gastroenterit gözlendi. Gruplarda bulunan hasta sayısı yetersiz olmakla birlikte gruplar arasında enfeksiyon sıklığı açısından istetistiksel olarak anlamlı fark bulunmaktadır (p<0.05).
Sonuç: Ülkemizin özellikle sosyo-ekonomik olarak geride kalmış bölgelerinde major cerrahi girişimler sonucu istirahat süreleri yeterli derecede kullanılamamaktadır. Bu çalışmada gelişen yüksek enfeksiyon sıklığı gözönüne alındığında, major cerrahi girişim ve splenektominin immün sistemde yarattığı defekte ilaveten, ağır çalışmaya sekonder oluşmuş olabilecek dehidratasyon ve malnutrisyonun da immün sistemi baskılamak suretiyle enfeksiyon gelişimine katkıda bulunduğunu düşünmekteyiz.

References

  • 1. Weledji, Elroy P. Benefits and risks of splenectomy. Int J Surg. 2014;12(2):113-9.
  • 2. King H. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136:239-42.
  • 3. Traub A, Giebink GS, Smith C, Kuni CC, Brekke ML, Edlund D et al. Splenic reticuloendothelial function after splenectomy, spleen repair and spleen autotransplantation. N Engl J Med. 1987;317(25):1559-64.
  • 4. Rosse WF. The spleen as a filter. N Engl J Med. 1987;17(11):704-6.
  • 5. Hosea SW, Brown EJ, Hamburger MI, Frank MM. Opsonic requirements for intravascular clearance after splenectomy. N Engl J Med. 1981;304(5):245-50.
  • 6. Thomsen RW, Schoonen WM, Farkas DK, Riis A, Jacobsen J, Fryzek JP et al. Risk for hospital contact with infection in patients with splenectomy: a population-based cohort study. Ann Intern Med. 2009;151(8):546-55.
  • 7. Shute PG. Splenectomy and susceptibility to malaria and babesiae infection. Br Med J. 1975;1(5956):516.
  • 8. Teo KG, Anavekar NS, Yazdabadi A, Ricketts S. Asplenic fulminant sepsis secondary to a dog bite complicated by toxic epidermal necrolysis/Stevemse Johnson syndrome. N Z Med J. 2012;125(1358):74-7.
  • 9. Barmparas G, Lamb AW, Lee D, Nguyen B, Eng J, Bloom MB et al. Postoperative infection risk after splenectomy: A prospective cohort study. Int J Surg. 2015;17:10-4.
  • 10. Hansen K, Singer DB. Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Dev Pathol. 2001;4(2):105-21.
  • 11. Dragomir M, Petrescu DGE, Manga GE, Călin GA, Vasilescu C. Patients After Splenectomy: Old risks and new perspectives. Chirurgia (Bucur). 2016;111(5):393-9.
  • 12. Sinwar PD. Overwhelming post splenectomy infection syndrome-review study. Int J Surg. 2014;12(12):1314-6.
  • 13. Skattum J, Naess PA, Gaarder C. Non-operative management and immune function after splenic injury. Br J Surg. 2012;99 Suppl 1:59-65.
  • 14. Bisharat N, Omari H, Lavi I, Raz R. Risk of infection and death among post-splenectomy patients. J Infect. 2001;43(3):182-6.
  • 15. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M et al. 2013 IDSA clinical practice guideline fo vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):309-18.
  • 16. Schwarzmann SW, Adler JL, Sullivan RJJ, Marine WM. Bacterial pneumonia during the Hong Kong influenza epidemic of 1968-1969. Arch Intern Med. 1971;127(6):1037-41.
  • 17. Wong KK, Jain S, Blanton L, Dhara R, Brammer L, Fry AM, Finelli L. Influenza-associated pediatric deaths in the United States, 2004-2012. Pediatrics. 2013;132(5):796-804.
There are 17 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Aybala Yıldız This is me

Alp Yıldız 0000-0002-6800-138X

Publication Date August 31, 2020
Submission Date July 18, 2019
Published in Issue Year 2020 Volume: 22 Issue: 2

Cite

APA Yıldız, A., & Yıldız, A. (2020). DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, 22(2), 159-162.
AMA Yıldız A, Yıldız A. DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?. Kırıkkale Uni Med J. August 2020;22(2):159-162.
Chicago Yıldız, Aybala, and Alp Yıldız. “DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22, no. 2 (August 2020): 159-62.
EndNote Yıldız A, Yıldız A (August 1, 2020) DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22 2 159–162.
IEEE A. Yıldız and A. Yıldız, “DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?”, Kırıkkale Uni Med J, vol. 22, no. 2, pp. 159–162, 2020.
ISNAD Yıldız, Aybala - Yıldız, Alp. “DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi 22/2 (August 2020), 159-162.
JAMA Yıldız A, Yıldız A. DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?. Kırıkkale Uni Med J. 2020;22:159–162.
MLA Yıldız, Aybala and Alp Yıldız. “DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?”. Kırıkkale Üniversitesi Tıp Fakültesi Dergisi, vol. 22, no. 2, 2020, pp. 159-62.
Vancouver Yıldız A, Yıldız A. DOES THE RESTING TIME AFTER EMERGENCY SPLENECTOMY AFFECT THE FREQUENCY OF POST-SPLENECTOMY INFECTIONS?. Kırıkkale Uni Med J. 2020;22(2):159-62.

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