Temporal trends of splenectomy in pediatric hospitalizations with hereditary spherocytosis from 2000 to 2019: A national survey

Abstract

AbstractBackgroundTotal and partial splenectomy are used in pediatric patients with hereditary spherocytosis to resolve anemia and hemolytic complications.ProcedureData from the Healthcare Cost and Utilization Project's Kid's Inpatient Database was used to profile and describe temporal trends in pediatric (≤18 years) hospital admissions in the United States from 2000 to 2019 data release years. Survey sampling methods were used to produce national estimates.ResultsFrom 2000 to 2019, the use of splenectomy declined overall, from 427 to 206 weighted procedures (difference = 222, 95% confidence interval [CI]: 124–320; p < .0001); the risk of undergoing splenectomy during admission also declined from 56.7% to 38.7% (risk difference = 17.9 percentage points [p.p.], 95% CI: 9.7–26.1; p < .0001). Total splenectomy was mostly used. Age at time of splenectomy increased 10.2 years (difference = 1.6 years, 95% CI: 0.6–2.7; p = .0018). The risk of splenectomy increased with age until 10 years, then leveled off until 18 years. The proportion of children aged ≤5 years undergoing splenectomy decreased from 27.7% to 11.2% in 2019 (risk difference: 16.5 p.p., 95% CI: 7.3–25.7; p = .0004). The strongest clinical predictors of splenectomy, adjusting for patient‐ and hospital‐level characteristics, were a co‐diagnosis of symptomatic cholelithiasis (adjusted odds ratio [aOR] = 3.18, 95% CI: 1.92–5.28; p < .0001) and splenomegaly or hypersplenism (aOR = 2.52, 95% CI: 1.74–3.65; p < .0001). Risk of splenectomy with splenomegaly or hypersplenism increased over time.ConclusionSplenectomy was delayed until age greater than 10 years. Older age, co‐diagnosis with splenomegaly or hypersplenism, or symptomatic cholelithiasis were strongest clinical predictors of splenectomy. Conservative management of hereditary spherocytosis appears to be more common.