Splenectomy Impact and Outcome Among Patients With Sickle Cell Disease: A Cross-Sectional Study.

BACKGROUND

It is common to perform a splenectomy for patients with sickle cell disease (SCD); however, our understanding of its impact on long-term clinical outcomes remains incomplete.

OBJECTIVES

To evaluate the clinical outcomes of splenectomy in SCD patients and to assess perioperative physician practices.

METHODS

This is a retrospective cross-sectional study that involved 245 adult Saudi patients with SCD, categorized into two groups: 40 patients who underwent splenectomy and 205 who did not. Data were gathered by structured interviews and electronic health records, including sociodemographic information, features of SCD, surgical procedures, and post-splenectomy outcomes.

RESULTS

The splenectomy group exhibited an increased frequency of acute chest syndrome (40% vs. 8.3%) and annual hospital admissions (8.7 vs. 3.35) due to pain crises before splenectomy. Following splenectomy, they demonstrated a notable decrease in hospital admissions and the need for blood transfusions (92.5% vs. 97.1%, 82.5% vs. 84.9%, respectively). Nevertheless, they exhibited a greater prevalence of stroke, venous thrombosis, and acute chest syndrome compared to the non-splenectomy group (15% vs. 2.4%, 12.5% vs. 2.9%, and 45% vs. 8.3%). Patients aged ≤ 33 years (p = 0.03) and those with comorbidities (p = 0.02) demonstrated a significant response to splenectomy.

CONCLUSION

Splenectomy in SCD patients may result in reduced hospital admissions and blood transfusion needs. Yet, it may elevate the risk of thromboembolic events and acute chest syndrome. Optimizing outcomes require careful patient selection and perioperative management.