The lost art of the splenorrhaphy

详细信息    查看全文

• 作者：Mary Arbuthnot ; ^{mary.kathleen.arbuthnot@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Chinwendu Onwubiko ^{chinwendo.onwubiko@childrens.harvard.edu" class="auth_mail" title="E-mail the corresponding author} ; David Mooney ^{david.mooney@childrens.harvard.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Pediatric ; Splenectomy ; Splenorrhaphy ; Trauma ; Proficiency ; Spleen
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：51
• 期：11
• 页码：1881-1884
• 全文大小：441 K

文摘

In the case of the hemodynamically unstable child, splenorrhaphy is preferred to splenectomy to avert postsplenectomy sepsis. However, successful splenorrhaphy requires familiarity with the procedure. We sought to determine how many splenectomies or splenorrhaphies for trauma the average pediatric surgeon can be expected to perform during their career.

Methods

The Pediatric Health Information System (PHIS) Database was queried for patients ≤ 18 years coded with an International Classification of Diseases 9th Edition diagnosis code of a splenic injury from 2004 to 2013. Age, gender, grade of splenic injury, and operations performed were extracted. Numbers of pediatric surgeons per hospital were obtained.

Results

9567 children were identified. 2.1% underwent a splenectomy and 0.8% underwent a splenorrhaphy. The average surgeon performed 0.6 (SD = 0.6) splenectomies and 0.2 (SD = 0.4) splenorrhaphies for trauma. If these rates remain constant over time, the average surgeon would perform 1.8 (SD = 1.7) splenectomies and 0.6 (SD = 1.1) splenorrhaphies for trauma over a 30-year surgical career.

Conclusion

Nonoperative management is associated with a host of benefits, but has resulted in a decrease in the experience level of the pediatric surgeons expected to perform an emergency splenectomy or splenorrhaphy when the unusual occasion arises.