Hereditary spherocytosis before and after splenectomy and risk of hospitalization for infection

Yakun Liu; Shaobin Jin; Ruone Xu; Cailin Ding; Wenbo Pang; Yang Li; Yajun Chen

doi:10.1038/s41390-022-02229-y

Hereditary spherocytosis before and after splenectomy and risk of hospitalization for infection

Pediatr Res. 2023 Apr;93(5):1336-1341. doi: 10.1038/s41390-022-02229-y. Epub 2022 Aug 1.

Authors

Yakun Liu¹, Shaobin Jin², Ruone Xu³, Cailin Ding¹, Wenbo Pang¹, Yang Li⁴, Yajun Chen⁵

Affiliations

¹ Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
² Department of Pediatric Surgery, Qilu Hospital of Shandong University, No. 107 West Wenhua Street, Jinan, Shandong, 250000, China.
³ Shanghai Medical College, Fudan University, No. 138 Yixueyuan Street, Shanghai, 200032, China.
⁴ Department of Pediatric Surgery, Qilu Hospital of Shandong University, No. 107 West Wenhua Street, Jinan, Shandong, 250000, China. ice0917@sina.com.
⁵ Department of General Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China. bch_chenyajun@163.com.

PMID: 35915237
DOI: 10.1038/s41390-022-02229-y

Abstract

Background: The infectious burden in hereditary spherocytosis (HS) children before splenectomy has rarely been reported and the risk of severe postsplenectomy infection is controversial.

Methods: We conducted a retrospective study of pediatric patients with HS to evaluate the risk of infection presplenectomy and postsplenectomy. The primary outcome was any bacterial, Mycoplasma, or fungal infection that required hospitalization. The secondary outcomes were sepsis and septic shock. Appendectomized children were matched on age at surgery and enrolled as controls.

Results: In all, 232 patients were included. Before splenectomy, the primary outcome was identified in 51 (22.0%) patients, and the secondary outcome was identified in 1 (0.4%) patient. After splenectomy, the primary and secondary outcomes were detected in 8 (4.1%) and 1 (0.5%) patients, respectively. The risk of infection was higher presplenectomy than postsplenectomy (OR, 6.6; 95% CI, 3.0-14.2). HS patients had a higher risk of infection than the controls before surgery (OR, 3.7; 95% CI, 2.3-5.9) but not after surgery (OR, 1.4; 95% CI, 0.6-3.6).

Conclusions: HS patients who require splenectomy later in life had a high incidence of hospitalization for infections. In contrast, postsplenectomy risk of hospitalization involving infection or severe infection was low.

Impact: Patients with hereditary spherocytosis who require splenectomy later in life have a high risk of hospital admission for infections, especially those with severe hereditary spherocytosis. With vaccines or postoperative antibiotics, splenectomy does not increase the risk of infection or severe infections. Splenectomy may reduce the risk of hospitalization for infections by alleviating the complications of hereditary spherocytosis. With vaccines, prophylaxis, or advanced antibiotics, the benefits of splenectomy in children with hereditary spherocytosis and a heavy disease burden may outweigh the risks.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Hospitalization
Humans
Retrospective Studies
Spherocytosis, Hereditary* / complications
Spherocytosis, Hereditary* / surgery
Splenectomy* / adverse effects