A. R. Alvarado1, K. F. Udobi1, S. D. Berry1, K. K. Assmann1, T. McDonald1, J. M. Howard1, A. W. Bennett1, M. Moncure1, J. Green1, R. D. Winfield1 1University Of Kansas,Surgery Trauma/Critical Care & Acute Surgery Division,Kansas City, KS, USA
Introduction:
Splenic injury is one of the most common injuries requiring surgical intervention. Following a total splenectomy, certain measures must be taken post-splenectomy to better prevent infection; namely, the postoperative administration of conjugate vaccinations against encapsulated bacteria (S. pneumoniae, N. meningitidis, and H. influenzae). While initial immunization is frequently completed prior to discharge from an acute inpatient stay, the Advisory Council on Immunization Practices (ACIP) recommends administration of an 8-week vaccination boosters against S. pneumoniae and N. meningitidis, and compliance with this practice is unknown. We hypothesized that patients undergoing splenectomy for trauma would not routinely receive the recommended immunization and subsequent booster.
Methods:
All trauma admissions at our Level I Trauma center who required a splenectomy secondary to trauma between January 1, 2010 and November 1, 2015 were included. Demographic and injury data, dates of splenectomies, immunization documentation, subsequent vaccination boosters received, and outcomes were collected from the medical record.
Results:
9,965 trauma patients were admitted during the time period studied. 44 patients underwent splenectomy, with 39 patients meeting all inclusion and exclusion criteria. Median age of the patient population was 45 years, 82% were male, and median injury severity score was 29. Seven patients expired during their index admission and were not immunized. The remaining 32 patients received initial immunizations prior to discharge, making in-hospital administration 100% compliant. Three received subsequent boosters during office or hospital visits; however, no patient received any booster within ACIP’s recommended eight-week timeframe with median time to subsequent boosters of 12 months, (range 6 to 32 months). Eight patients have had a subsequent admission for infection or sepsis, with one patient expiring secondary to infection. None of the patients subsequently admitted for infection or sepsis had received subsequent boosters.
Conclusion:
While trauma patients at our institution routinely receive immunization against encapsulated bacteria following splenectomy prior to hospital discharge, they receive booster vaccinations at a suboptimal rate and beyond the advised eight-week window. We speculate that this phenomenon is widespread in the American trauma population. These data suggest a need for improved patient and provider education as well as coordination with primary care practitioners to ensure ideal defense against infectious complications.