Will partial splenic embolization followed by splenectomy increase intraoperative bleeding?

Table 1 Comparison of perioperative characteristics of included patients between the two groups by propensity score matching analysis

Variables	Unmatched		P value	Matched		P value
	PSE group, n = 40	Non-PSE group, n = 281		PSE group, n = 23	Non-PSE group, n = 23
Age in yr	33.95 ± 12.21	35.07 ± 14.74	0.65	33.57 ± 13.56	34.04 ± 12.23	0.90
Sex, n (%)			0.12			0.57
Male	17	156		12	10
Female	23	125		11	13
Etiology of cirrhosis, n (%)			0.88			0.30
HLD cirrhosis	34	222		19	17
HBV cirrhosis	4	48		3	4
HCV cirrhosis	1	3		1	1
Schistosomiasis cirrhosis	0	1		0	0
Alcoholic cirrhosis	0	2		0	0
Autoimmunity cirrhosis	1	3		0	1
Unknown	0	1
The size of spleen in mm
Length of spleen	161.85 ± 21.26	171.21 ± 26.74	0.04	170.13 ± 15.64	163.00 ± 25.33	0.26
Thickness of spleen	66.45 ± 11.03	73.06 ± 16.91	0.02	69.74 ± 8.77	64.43 ± 15.88	0.17
The diameter of portal vein system in cm
Portal vein	1.35 ± 0.16	1.41 ± 0.24	0.15	1.38 ± 0.19	1.28 ± 0.17	0.50
Splenic vein	1.24 ± 0.21	1.23 ± 0.24	0.71	1.23 ± 0.23	1.13 ± 0.17	0.10
Preoperative blood examination
WBC as 109/L	2.69 ± 1.05	3.13 ± 2.08	0.19	2.51 ± 1.09	3.12 ± 2.44	0.28
RBC as 1012/L	3.76 ± 0.37	3.91 ± 0.65	0.16	3.77 ± 0.43	3.58 ± 0.54	0.18
HGB in g/L	106.40 ± 18.31	109.75 ± 18.71	0.29	103.61 ± 16.80	104.96 ± 15.08	0.75
PLT as 109/L	66.35 ± 30.04	50.03 ± 28.68	0	59.26 ± 29.86	59.04 ± 48.48	0.99
TBIL in μmol/L	34.54 ± 25.58	22.98 ± 15.61	0	30.09 ± 26.63	28.14 ± 22.13	0.79
ALT in U/L	30.20 ± 13.31	29.01 ± 17.01	0.67	28.74 ± 13.03	28.96 ± 21.20	0.97
AST in U/L	38.00 ± 16.13	30.00 ± 11.44	0	33.57 ± 11.18	35.48 ± 17.46	0.66
ALB in g/L	35.04 ± 3.42	37.60 ± 4.60	0	34.77 ± 3.07	34.98 ± 3.98	0.84
PT in s	14.95 ± 3.44	14.70 ± 2.43	0.57	15.08 ± 3.49	14.30 ± 2.26	0.37
D-dimer in mg/L	1.46 ± 4.28	0.67 ± 0.83	0.01	0.47 ± 0.26	0.56 ± 0.54	0.47
Operation, n (%)
Splenectomy only	18	237	0	11	11	1
Concomitant pericardial devascularization	22	44		12	12
Intraoperative outcomes
Intraoperative blood loss in mL	399.50 ± 240.76	267.36 ± 161.07	0	450.00 ± 268.40	250.13 ± 129.02	0
Operation time in min	202.98 ± 36.38	181.64 ± 36.57	0.01	220.09 ± 35.41	189.78 ± 37.42	0.01
Postoperative complications, n (%)
PVT	14	107	0.71	8	6	0.53
PPF	6	27	0.30	4	4	1
Abdominal hemorrhage	3	6	0.06	2	3	0.65
Hospital stay in d	17.10 ± 4.42	13.99 ± 3.57	0	16.70 ± 4.18	13.52 ± 2.25	0

ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HBV: Hepatitis B virus; HCV: Hepatitis C virus; HGB: Hemoglobin; HLD: Hepatolenticular degeneration; PLT: Platelet; PPF: Postoperative pancreatic fistula; PSE: Partial splenic embolization; PSM: Propensity score matching; PT: Prothrombin time; PVT: Portal vein thrombosis; RBC: Red blood cell; TBIL: Total bilirubin; WBC: White blood cell.

Table 2 Demographic and preoperative clinical characteristics between pre-/post-propensity score matching

Variables	Groups		t	P value
	Pre-PSE group, n = 40	Post-PSE group, n = 40
Frequency	1.50 ± 0.82
Time from last PSE to surgery in mo	5.03 ± 9.53
The size of spleen in mm
Length of spleen	171.70 ± 25.07	161.85 ± 21.26	18.28	0.06
Thickness of spleen	71.45 ± 14.07	66.45 ± 11.03	7.309	0.08
The diameter of portal vein system in cm
Portal vein	1.57 ± 0.16	1.35 ± 0.16	8.953	0
Splenic vein	1.47 ± 0.19	1.24 ± 0.21	5.956	0
Preoperative blood examination
WBC as 109/L	2.87 ± 0.93	2.69 ± 1.05	3.684	0.40
RBC as 1012/L	3.67 ± 0.23	3.76 ± 0.37	0.609	0.18
HGB in g/L	119.1 ± 6.30	106.40 ± 18.31	1.071	0
PLT as 109/L	28.55 ± 14.29	66.35 ± 30.04	4.15	0
TBIL in μmol/L	54.68 ± 16.26	34.54 ± 25.58	5.195	0
ALT in U/L	58.0 ± 17.32	30.20 ± 13.31	3.378	0
AST in U/L	77.15 ± 17.02	38.00 ± 16.13	8.136	0
ALB in g/L	29.90 ± 1.49	35.04 ± 3.42	1.844	0
PT in s	17.97 ± 1.09	14.95 ± 3.44	2.091	0
D-dimer in mg/L	0.33 ± 0.12	1.46 ± 4.28	3.756	0.10

ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; HGB: Hemoglobin; PLT: Platelet; PSE: Partial splenic embolization; PT: Prothrombin time RBC: Red blood cell; TBIL: Total bilirubin; WBC: White blood cell.

Table 3 Risk factors of intraoperative bleeding using the uni- and multi-variate analyses

Characteristics	Univariate analysis			Multivariate analysis
	Non-IB group, n = 20	IB group, n = 26	P value	β	S.E.	Wald	Odds ratio	95%CI	P value
ALB in g/L	36.34 ± 3.49	33.75 ± 3.15	0.01	-0.73	0.42	2.982	0.482	0.21-1.104	0.08
PT in s	13.70 ± 2.66	15.45 ± 2.95	0.04	0.336	0.34	3.724	1.94	0.99-3.802	0.05
LS in mm	152.25 ± 13.21	177.58 ± 19.51	0	0.123	0.06	5.003	1.131	1.015-1.259	0.03
Thickness of spleen in mm	62.10 ± 13.96	70.92 ± 10.92	0.02	0.095	0.05	3.216	1.1	0.991-1.221	0.07
PVD in cm	1.25 ± 0.15	1.40 ± 0.19	0.01	18.86	8.64	4.761	2E + 08	6.806-3.516E + 15	0.03
SVD in cm	1.11 ± 0.18	1.24 ± 0.22	0.04	-20	9.26	4.658	0	0-0.16	0.03
PSE history, n	0.8 ± 0.41	0.27 ± 0.45	0	-4.44	2.01	4.863	0.012	0-0.610	0.03

ALB: Albumin; IB: Intraoperative bleeding; LS: The length of the spleen; PSE: Partial splenic embolization; PT: Prothrombin time; PVD: Portal vein diameter; SVD: Splenic vein diameter.