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Splenectomy & Short-Term Survival

Clinician's Brief (Capsule)

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In dogs, splenic masses are common and possibly life-threatening. Although there is information available about long-term survival in dogs undergoing splenic surgery, less is available regarding short-term survival. In this retrospective study, the medical records of 539 dogs were reviewed. All had undergone splenectomy for known splenic mass at a large academic referral hospital. The most common malignant tumor was hemangiosarcoma (n = 228); the most common non-neoplastic lesion was hematoma (n = 104). Perioperative mortality rate was 41/539 (7.6%). Twenty-one dogs died following cardiopulmonary arrest, and 20 were euthanized because they were considered moribund. Causes of death included uncontrollable hemorrhage (n = 10), known or suspected portal system thrombosis (n = 9), suspected pulmonary thromboembolism (n = 4), known or suspected pneumonia (n = 4), and known or suspected disseminated intravascular coagulation (n = 3). For each decrease in platelet count of 10,000 platelets/µl at admission, odds of death increased 6%. Platelet counts may serve as a valuable gauge of overall coagulation status in smaller practices where coagulation testing may not be readily available. Dogs with a PCV <30% or dogs that developed cardiac arrhythmia during surgery were twice as likely to die as dogs with a PCV >30% or dogs that did not develop arrhythmia. Results indicate that reductions in perioperative mortality rate could potentially be achieved through improved recognition and treatment of hemorrhage and thrombotic and coagulopathic syndromes.

Global Commentary

Splenic masses are a common disease in general practice. Most cases are probably asymptomatic until there is acute blood loss caused by splenic mass rupture, which is why the survival of these cases is challenging. This study found 3 risk factors for perioperative death; whether the mass was neoplastic was not a risk factor. That is a key point in decision making—not only for practitioners but also for pet owners. For them, it is difficult to authorize surgery in cases where long-term prognosis is guarded. In this paper, we see that the risk factors for peri-operative death are the same in neoplastic and non-neoplastic lesions, and all surgeons know that a mass with neoplastic aspects can be a hematoma or vice versa. The risk factors reported here can be useful in clinical cases, and our efforts need to be focused on preoperative stabilization and monitoring to reduce the perioperative mortality rate.—Esteban Pujol, DVM, DECVS, Spain

This capsule is part of the WSAVA Global Edition of Clinician's Brief. 

References

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