Analysis of postoperative complications and risk factors in patients with portal hypertension treated by laparoscopic splenectomy

Abstract

Objective To investigate the postoperative complications after laparoscopic splenectomy for patients with portal hypertension,and analyze the risk factors for postoperative complications.Methods The clinical data of 65 patients with portal hypertension who received laparoscopic splenectomy at the West China Hospital from September 2003 to September 2012 were retrospectively analyzed.The postoperative complications were analyzed using the modified Clavien classification system,and the risk factors for postoperative complications were analyzed.The measurement data and the count data were analyzed using the t test,chi-square test or the Fisher exact probability.The univariate and multivariate analysis were done using the Logistic regression model.Results Twenty-nine patients received hand-assisted laparoscopic splenectomy and 36 received total laparoscopic splenectomy (2 patients were converted to open surgery due to intraoperative bleeding).Sixteen patients had 20 complications.The incidence of postoperative complications of the hand-assisted laparoscopic group was 10.3％ (3/29),which was significantly lower than 38.2％ (13/34) of the total laparoscopic group (x2 =3.90,P ＜ 0.05).According to the modified Clavien classification system,there were 4 patients with grade Ⅰ complication,2 patients with grade Ⅱ complication,8 patients with grade Ⅲ a complication,1 with grade Ⅲ b complication,1 with grade Ⅳa complication,and no Ⅳb or Ⅴ complication was observed.The duration of postoperative hospital stay was (8.4 ± 2.9) days.For patients with grade Ⅱ,Ⅲ and Ⅳ complications,the duration of postoperative hospital stay was (10.1 ± 3.3) days,which was significantly longer than (7.7 ± 2.5) days of patients with grade Ⅰ complication or without complications (t =4.30,P ＜ 0.05).The results of univariate analysis showed that ASA classification and application of hand-associated device were risk factors for postoperative complications (x2=21.60,5.10,P ＜0.05).The results of multivariate analysis showed that ASA grade Ⅲ and non-application of hand-assisted device were independent risk factors for postoperative complications (OR =23.60,4.60,P ＜ 0.05).The incidence of postoperative complications of patients with ASA grade Ⅲ were 17.00 times higher than patients with ASA grade Ⅱ,and the incidence of postoperative complications of patients who received total laparoscopic splenectomy was 5.00 times higher than those who received hand-assisted laparoscopic splenectomy.Conclusions The incidence of postoperative complications is higher in patients with portal hypertension,while the severity of the complications is under ASA grade Ⅲ.ASA classification and application of hand-assisted device are correlated with the incidence of postoperative complications. Key words: Portal hypertension ; Laparoscopy ; Splenectomy ; Complications