Splenectomy versus Imaging-Guided Percutaneous Drainage for Splenic Abscess: A Systematic Review and Meta-Analysis

Barite Gutama, Jillian K. Wothe, Mengli Xiao, Dawn Hackman, Haitao Chu, Jennifer Rickard

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: Splenic abscess (SA) is a rare, life-Threatening illness that is generally treated with splenectomy. However, this is associated with high mortality and morbidity. Recently, percutaneous drainage (PD) has emerged as an alternative therapy in select patients. In this study, we compare mortality and complications in patients with SA treated with splenectomy versus PD. Patients and Methods: A systematic literature search of 13 databases and online search engines was conducted from 2019 to 2020. A bivariate generalized linear mixed model (BGLMM) was used to conduct a separate meta-Analysis for both mortality and complications. We used the risk of bias in non-randomized studies of interventions (ROBINS-I) tool to evaluate risk of bias in non-randomized studies, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for assessing quality of evidence and strength of recommendations. Results were presented according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: The review included 46 retrospective studies from 21 countries. For mortality rate, 27 studies compared splenectomy and PD whereas 10 used PD only and nine used splenectomy only. Data for major complications were available in 18 two-Arm studies, seven single-Arm studies with PD, and seven single-Arm studies with splenectomy. Of a total of 589 patients, 288 were treated with splenectomy and 301 underwent PD. Mortality rate was 12% (95% confidence interval [CI], 8%-17%) in patients undergoing splenectomy compared with 8% (95% CI, 4%-13%) with PD. Complication rates were 26% (95% CI, 16%-37%) in the splenectomy group compared with 10% (95% CI, 4%-17%) in the PD group. Conclusions: Percutaneous drainage s associated with a trend toward lower complications and mortality rates compared with splenectomy in the treatment of SA, however, these findings were not statistically significant. Because of the heterogeneity of the data, further prospective studies are needed to draw definitive conclusions.

Original languageEnglish (US)
Pages (from-to)417-429
Number of pages13
JournalSurgical infections
Volume23
Issue number5
DOIs
StatePublished - Jun 1 2022

Bibliographical note

Funding Information:
Research reported in this publication was partially supported by the National Center for Advancing Translational Sciences Award Number UL1-TR002494 and the National Library of Medicine Award Number R01LM012982 of the National Institutes of Health.

Publisher Copyright:
© 2022, Mary Ann Liebert, Inc., publishers 2022.

Keywords

  • Complications
  • Mortality
  • Percutaneous drainage
  • Splenectomy
  • Splenic abscess

PubMed: MeSH publication types

  • Journal Article
  • Meta-Analysis
  • Review
  • Systematic Review

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