Human albumin is frequently administered during perioperative care because of its physiological role in maintaining plasma oncotic pressure and modulating the inflammatory response. However, increasing evidence suggests that albumin is often prescribed outside guideline-supported indications, particularly in surgical patients with preserved serum albumin levels. However, the clinical benefits of perioperative albumin administration in this population remain uncertain. To evaluate the association between perioperative albumin administration and short-term postoperative outcomes in patients undergoing gastrointestinal tumor surgery with preserved preoperative serum albumin concentrations. This retrospective cohort study included adult patients who underwent gastrointestinal tumor resection at a tertiary teaching hospital. Patients with preoperative serum albumin concentrations ≥ 31 g/L were eligible. Propensity score matching (1:1) was used to balance the baseline characteristics between patients who received perioperative albumin and those who did not. The primary outcome was the incision drainage volume on postoperative day 2. Secondary outcomes included cumulative incision drainage volume on postoperative days 1-3, recovery-period serum albumin concentration, and postoperative hospital length of stay. Multivariable linear regression analyses were performed to evaluate the association between albumin administration and the outcomes. After propensity score matching, 248 patients (124 per group) were included in the final analysis of the study. Perioperative albumin administration was not associated with reduced incision-drainage volume on postoperative day 2 or during postoperative days 1-3 (p > 0.05). Albumin administration was independently associated with higher recovery-period serum albumin concentrations (t = 3.996, p < 0.001). However, patients receiving albumin had significantly longer postoperative hospital stays than those who did not (p = 0.002). Among patients undergoing gastrointestinal tumor surgery with preserved preoperative serum albumin levels, perioperative albumin administration was not associated with improvements in early postoperative drainage outcomes and was associated with longer hospitalization, despite increasing serum albumin levels. These findings suggest that routine perioperative albumin administration in patients without hypoalbuminemia may provide limited clinical benefits and should be carefully evaluated in clinical practice.
Depression affects up to half of bariatric surgery candidates, yet the impact of depression severity and preoperative antidepressant pharmacotherapy use on surgical outcomes remains poorly characterized. This was a retrospective cohort study of patients who underwent primary minimally invasive sleeve gastrectomy or Roux-en-Y gastric bypass at a single institution between January 2018 and June 2024. Depression severity was stratified using PHQ-9 scores obtained during standard preoperative psychological evaluation. Antidepressant use was classified by pharmacologic class and number of concurrent medications. The primary outcome was percent excess body weight loss (%EBWL) at 6, 12, 24, 36, 48, and 60 months postoperatively. Secondary outcomes included 30-day perioperative complications, readmissions, and emergency department visits. Of 930 patients identified, 128 (13.8%) carried a preoperative depression diagnosis. Patients with depression achieved significantly greater %EBWL at 6 months (46.9% vs. 43.1%, p = 0.026), 1 year (56.9% vs. 52.0%, p = 0.012), and 2 years (59.0% vs. 50.4%, p = 0.007) compared to those without depression, with no significant differences at later timepoints. Among patients with depression, those with none/minimal PHQ-9 severity had significantly greater %EBWL at 1 year compared to mild/moderate and moderately severe/severe groups (p = 0.031). No significant differences in 30-day perioperative complications were observed based on depression diagnosis or PHQ-9 severity category. However, patients with depression who were not taking antidepressants had significantly higher overall complication rates (11.5% vs. 0%, p = 0.002) and 30-day readmission rates (15.4% vs. 3.0%, p = 0.045) compared to those receiving antidepressant therapy. Preoperative depression is not a contraindication to bariatric surgery; patients with depression can achieve excellent short-term weight loss, particularly in the first two postoperative years. Optimizing preoperative depression treatment appears to reduce perioperative morbidity and may confer a protective effect on perioperative outcomes in this population.
Nasal fractures are the most common facial fractures, yet national benchmarks for perioperative outcomes and drivers of surgical decision-making remain poorly defined. Leveraging nearly 2 decades of multi-institutional data, this study establishes contemporary standards of perioperative safety and characterizes factors influencing operative approach. A retrospective cohort study using the ACS-NSQIP database (2007-2024) identified adult patients who underwent operative nasal fracture repair. Patients were stratified by operative approach (closed vs. open reduction). The primary outcome was any 30-day postoperative complication. Secondary analyses evaluated determinants of operative approach, sensitivity to concurrent craniofacial procedures, and specialty-based practice patterns. Multivariable logistic regression was used to identify independent predictors of operative approach. Among 455 patients, 80.4% underwent closed and 19.6% open reduction. Across nearly 2 decades of national data, operative nasal fracture management demonstrated an exceptionally low complication rate of 1.5%, with no surgical site infections or mortality and no difference between approaches (1.4% vs. 2.2%, P=0.63). All complications represented return-to-operating-room events. Operative time (OR=1.004 per minute, P<0.001) and wound classification (OR=1.77 per class, P=0.013) independently predicted open reduction, whereas patient comorbidity was not associated with operative approach. Findings were consistent across sensitivity analyses. Specialty-based analysis demonstrated equivalent complication rates between otolaryngology and plastic surgery (1.7% vs. 1.7%, P=1.0), despite differences in operative approach selection. This national analysis provides benchmark-level evidence that operative management of nasal fractures is uniformly safe, with negligible perioperative morbidity across practice settings. The operative approach is dictated by injury complexity rather than patient risk, thereby supporting an anatomy-driven treatment paradigm. These findings define a national reference standard for perioperative safety and provide a foundation for future outcome-driven and patient-centered studies.
Lung cancer surgery is a cornerstone of curative treatment for resectable disease, but postoperative recovery is often prolonged and may be complicated by impaired pulmonary function, reduced physical activity, symptom burden and delayed functional restoration. Wearable devices may support perioperative physical activity through objective monitoring and activity promotion; however, existing evidence remains fragmented and has not been synthesised in a focused review. This protocol describes a systematic review and meta-analysis to evaluate the association of wearable device-based perioperative physical activity with recovery outcomes in patients undergoing lung cancer surgery. We will include randomised controlled trials, non-randomised interventional studies and prospective or retrospective cohort studies involving adults undergoing surgery for suspected or confirmed primary lung cancer. Eligible studies must examine wearable device-based perioperative physical activity during the preoperative period, postoperative period or both. The primary outcomes will be postoperative pulmonary complications, length of hospital stay and physical function or exercise capacity. Secondary outcomes will include overall postoperative complications, pulmonary function, symptom burden, health-related quality of life, chest tube duration, readmission and postoperative mortality. We will search PubMed, EMBASE, Web of Science, CINAHL and the Cochrane Library from inception to the final search date, supplemented by reference screening, forward citation tracking, grey literature and trial registry searches. Two reviewers will independently perform study selection, data extraction and risk-of-bias assessment. Where appropriate, meta-analysis will be performed using random-effects models; otherwise, findings will be synthesised narratively. Ethical approval is not required because this review will use data from published studies and publicly accessible sources only and will not involve individual participants or identifiable personal data. The findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic or professional conferences. CRD420261375254.
Postoperative pain remains a major challenge after lung cancer surgery and may negatively affect recovery, functional status, and quality of life. Structured perioperative educational interventions may improve symptom management and postoperative outcomes. This study evaluated the effect of a structured educational intervention on postoperative pain outcomes in patients undergoing lung cancer surgery. This prospective, single-center, non-randomized interventional study included 160 patients undergoing surgical treatment for lung cancer between October 2021 and March 2024. Participants were allocated to either an intervention group (n=80), which received structured perioperative education in addition to usual care, or a control group (n=80), which received usual care alone. The educational intervention was delivered preoperatively and reinforced during the first three postoperative days, with caregiver participation encouraged. Pain outcomes were assessed preoperatively and at 1, 6, and 12 months postoperatively using the Greek-language Pain Rating Scale. The primary outcome was current pain intensity. Secondary outcomes included average pain intensity during the previous week, pain distress, and pain-related interference with daily activities. Longitudinal analyses were performed using linear mixed-effects models. Significant group, time, and group × time interaction effects were observed for all pain-related outcomes (all p<0.001). Compared with the control group, patients receiving the educational intervention demonstrated significantly lower postoperative pain intensity, reduced pain distress, and less pain-related interference with daily activities across follow-up assessments. The largest between-group differences were generally observed at six months postoperatively. Sensitivity analyses adjusting for baseline pain scores, length of hospital stay, and immunotherapy confirmed the robustness of the findings. Structured perioperative education was associated with improved postoperative pain outcomes following lung cancer surgery. Educational interventions incorporating caregiver involvement and reinforcement during the early postoperative period may represent a feasible and low-risk supportive strategy to improve postoperative recovery and pain management in patients undergoing thoracic surgery. Further randomized multicenter studies are warranted to confirm these findings.
Perioperative hypoxia remains a common clinical complication. Allogeneic blood transfusion and conventional oxygen support are widely used but limited by blood shortage, supply constraints and ethical challenges. Perfluorocarbon-based oxygen carriers (PFCs) possess superior oxygen solubility and favorable physicochemical features, making promising candidate adjuncts to improve perioperative oxygenation, despite multiple unresolved translational drawbacks. This scoping review strictly followed the PRISMA-ScR standard. Six mainstream databases were systematically searched for English human and animal studies published from 2000 to 2025 focusing on perioperative and surgical applications of PFCs; eligible literature was screened and data extracted based on predefined criteria. A total of 55 publications including 13 randomized controlled trials were enrolled. Preclinical and clinical data demonstrated PFC effectively improves tissue oxygenation and organ protection across hemorrhagic shock, brain injury and acute lung injury, with the most consistent therapeutic gains observed in organ preservation. PFC can reduce allogeneic transfusion requirements during major surgery and benefit cerebral ischemia management, while inflammatory side effects, thrombocytopenia and other adverse reactions have been repeatedly documented. PFCs show encouraging tissue-protective effects particularly in organ preservation, yet its broad clinical translation is hindered by inherent limitations such as high oxygen dependence, CARPA, reticuloendothelial deposition and historical failure of classic formulations. Further optimized formulation design and large-scale clinical trials are mandatory to improve safety and realize targeted clinical application.
To evaluate the association between perioperative variables, including extracorporeal membrane oxygenation bridge-to-transplantation (ECMO BTT), and the development of dysphagia after lung transplantation (LT), and to examine the association between postoperative dysphagia and long-term survival. This retrospective, single-center study included adult patients who underwent LT between November 2008 and December 2022. Swallowing function was assessed using the Functional Oral Intake Scale (FOIS) on postoperative day (POD) 28, POD 60, and at hospital discharge. Patients were classified into dysphagia (FOIS ≤3) and non-dysphagia (FOIS >3) groups based on FOIS at POD 28. Perioperative variables associated with dysphagia were examined using multivariable logistic regression. Survival outcomes were assessed using Kaplan-Meier analysis. Among the 124 included patients, 35.9% had dysphagia at POD 28, whereas 87.1% achieved functional oral intake by hospital discharge. Prolonged ECMO BTT (≥14 days), tracheostomy before POD 28, female sex, and postoperative pneumonia were independently associated with dysphagia at POD 28. Patients with dysphagia at POD 28 showed significantly poorer unadjusted 1-year and 2-year survival than those without dysphagia. Dysphagia at POD 28 after LT was associated with prolonged ECMO BTT, tracheostomy before POD 28, postoperative pneumonia, and poorer unadjusted survival. FOIS at POD 28 may serve as a clinically meaningful marker of delayed recovery and increased clinical vulnerability.
Doxorubicin-cyclophosphamide (AC) and docetaxel-cyclophosphamide (TC) are standard perioperative chemotherapy regimens for breast cancer. Febrile neutropenia (FN) is a common adverse event, and odontogenic infections may contribute to febrile episodes. This study was performed to investigate the incidence and impact of febrile episodes clinically associated with odontogenic infections during AC and TC chemotherapy. A total of 408 patients with breast cancer receiving 4 cycles of AC (n = 285) or TC (n = 123) between 2015 and 2020 were included in this single-center retrospective study. Patients recorded daily axillary temperatures and oral symptoms. Dental evaluations were performed when oral infection was suspected. Febrile episodes (≥ 37.5 °C) were assessed, and their clinical association with odontogenic infections was determined based on dental records and the documented clinical course. Relative dose intensity (RDI) was calculated to assess chemotherapy delivery. Overall, 40.2% of patients experienced febrile episodes, and the frequency was higher in the TC group (48.8%) than the AC group (36.5%, P = 0.02). Febrile episodes associated with oral infections occurred in 9.1% of patients, of which 78.4% were clinically associated with odontogenic infections (7.1% of all patients). Most such episodes occurred during the first chemotherapy cycle (79.3%, P < 0.01). Chemotherapy RDI was reduced in three patients with febrile episodes clinically associated with odontogenic infection, but remained ≥ 85%. Febrile episodes clinically associated with odontogenic infections occurred in approximately 7%-8% of patients with breast cancer receiving perioperative AC or TC chemotherapy, predominantly during the first cycle. Odontogenic infections should be considered one possible source of febrile episodes during treatment.
Inappropriate antibiotic allergy labeling often leads to the unnecessary avoidance of first-line therapies. The present study aimed to evaluate the current status of antibiotic allergy documentation and its assessment in patients undergoing surgery for which cefazolin was the recommended first-line prophylaxis in a Japanese hospital. This retrospective observational study was conducted at a university hospital in Tokyo from 2021 to 2023; included patients with a history of antimicrobial allergy who underwent surgery for which cefazolin was recommended; and assessed patient demographics, details of the allergies in electronic health records (EHR), and perioperatively administered antimicrobial agents. Of 2,402 eligible patients, 243 (10.1%) had a registered antimicrobial allergy. The drug classes most frequently recorded in the EHR were cephalosporins (25.0%) and penicillins (24.0%). Documentation of allergy assessments by a physician (9.0%) or specialist (7.0%) was rare. Although 51.9% of the labeled patients had received cefazolin, non-first-line agents had also been frequently administered. Notably, clindamycin had been administered to 30% of the cases and had been widely used even among patients with only a penicillin allergy label despite the low risk of cross-reactivity. Antibiotic allergy labels in the EHR were often incomplete, infrequently assessed, and associated with substantial avoidance of first-line prophylaxis. Redesigning the EHR format to allow allergies to be distinguished from adverse events while retaining the standard evaluation pathways is essential to optimizing perioperative antimicrobial stewardship.
The ongoing PROTEUS study aims to evaluate the effectiveness of perioperative Apalutamide combined with androgen-deprivation therapy in improving oncological outcomes for a specifically defined high-risk prostate cancer (PCa) group who were treated with radical prostatectomy (RP). Interestingly, the PROTEUS inclusion criteria did not rely on established risk categories such as the European Association of Urology (EAU) or the National Comprehensive Cancer Network (NCCN) high-risk classification. Consequently, little is known about the natural course of patients eligible for PROTEUS who were diagnosed with high-risk PCa and treated with RP without receiving any neoadjuvant systemic treatment. To address this knowledge gap, this analysis included 701 patients eligible for PROTEUS who have undergone RP, revealing that a significant proportion did not fit into the established high-risk classifications (EAU high-risk: 58.2% and NCCN high-risk: 53.1%). Event-free survival (EFS) rates at 36 and 60 mo of the overall cohort of patients eligible for PROTEUS were 57.6% (95% confidence interval [CI]: 53.9-61.7) and 45.9% (95% CI: 41.9-50.4), respectively. Notably, patients solely eligible for PROTEUS criteria exhibited more favorable EFS rates than those who also met EAU and/or NCCN high-risk criteria. This study highlights the need to enhance treatment strategies for patients with high-risk PCa and suggests potential implications for future research based on PROTEUS data. The results aim to inform clinical practices and the understanding the natural history and its outcomes of patients eligible for PROTEUS who were diagnosed with PCa and underwent RP without neoadjuvant systemic treatment.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) slow gastric emptying and may therefore increase the risk of retained gastric contents (RGC). The optimal duration of discontinuation before esophagogastroduodenoscopy (EGD) under sedation or general anesthesia remains controversial. We conducted a single-center, retrospective, observational study of patients who underwent elective EGD between August 2023 and May 2025. According to GLP-1RA exposure, patients were classified as (i) no GLP-1RA use, (ii) GLP-1RA continued use, or (iii) GLP-1RA two-week hold. The primary outcome was the presence of RGC, defined as any solid residue or > 100 mL of fluid visualized during EGD. Multivariate logistic regression was used to explore the relationship between GLP-1RA use and RGC. RGC occurred in 0.4% (63/15902) of patients with no GLP-1RA use, 5.83% (6/103) of patients with GLP-1RA continued use, and 1.61% (1/62) of patients with GLP-1RA two-week hold. GLP-1RA continued use was associated with a tenfold higher RGC risk versus no GLP-1RA use (odds ratio [OR] 10.68, 95% CI 3.74-30.55; p < 0.001), whereas a two-week hold reduced risk to a level statistically comparable with no GLP-1RA use (OR 2.99, 95% CI 0.37-23.89, p = 0.302). Obesity (BMI ≥ 28 kg/m2) independently increased RGC risk and, even after a two-week hold, yielded a tenfold higher risk of RGC versus no GLP-1RA use. Additionally, concurrent colonoscopy exerted a strong protective effect of RGC, and no RGC events occurred in patients with GLP-1RA two-week hold and concurrent colonoscopy. A two-week hold of GLP-1RA lowered RGC incidence to a low level comparable with no GLP-1RA use, especially in normal-weight or overweight patients and in those undergoing concurrent colonoscopy, but may be insufficient for obesity.
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This is Part II of a Society for the Advancement of Transplant Anesthesia white paper providing evidence-based recommendations for the use of point-of-care ultrasound (PoCUS) during and after abdominal organ transplantation. The white paper was developed by experts in abdominal transplant anesthesia and critical care after review of the current literature and practice behaviors. The recommendations are organized by phase of care: preoperative, intraoperative, and postoperative. In Part II, we focus on the use of PoCUS in the immediate postoperative and intensive care setting to guide fluid management, recognize venous congestion, identify causes of acute kidney injury and shock, estimate hemodynamics, and screen for increased intracranial pressure after abdominal organ transplantation.
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Neoadjuvant immune checkpoint inhibition (ICI) has demonstrated high pathological response rates in resectable stage III melanoma and is increasingly used for selected patients with low-volume stage IV disease. However, the surgical and perioperative implications remain incompletely defined. A systematic review and meta-analysis were performed to evaluate oncologic, surgical, and immune-related outcomes following neoadjuvant ICI and curative-intent surgery. MEDLINE, EMBASE, and the Cochrane Library, were systemically searched for both prospective and retrospective studies including adults with resectable stage III or oligometastatic stage IV melanoma treated with neoadjuvant ICI followed by planned surgery. Outcomes included pathological response, recurrence, failure or delay to surgery, perioperative complications, and treatment-related adverse events. Pooled estimates were calculated using random-effects meta-analyses. A total of 20 studies comprising 1384 patients were included. The pooled proportions of pathological complete response were 0.33 (CI 0.26-0.40), major pathological response 0.46 (CI 0.38-0.54), and overall pathological response 0.59 (CI 0.51-0.67). Pathological nonresponse occurred in 0.30 (CI 0.25-0.36). Failure or delay to surgery occurred in 0.09 (CI 0.07-0.12), with disease progression during neoadjuvant therapy reported in 0.06 (CI 0.04-0.10). Major perioperative complications (Clavien-Dindo ≥ III) occurred in 0.08 (CI 0.05-0.13), while major treatment-related toxicities (CTCAE grade ≥ III) occurred in 0.25 (CI 0.18-0.34). Comparative analyses demonstrated similar perioperative complication rates between neoadjuvant and adjuvant approaches, with lower recurrence risk favoring neoadjuvant therapy (p < 0.01). Neoadjuvant ICI produces substantial pathological responses while preserving surgical feasibility in resectable stage III and selected stage IV melanoma. Operative morbidity appears acceptable; however, systemic toxicity is common, and perioperative reporting remains heterogeneous.
Robot-assisted partial nephrectomy (RAPN) is currently the gold standard for localized renal tumors. The surgical approach can be performed using either an on-clamp or off-clamp technique. The aim of the study is to evaluate differences in positive surgical margins (PSMs) and perioperative complications between on-clamp and off-clamp approaches of RAPN, at all levels of tumor complexity. We retrospectively enrolled 478 patients who underwent RAPN between 1/2020 and 6/2024 and divided into two groups: A (on-clamp) and B (off-clamp). We stratified tumor complexity according to the RENAL score and analyzed all perioperative and oncological outcomes: PSMs, post-operative creatinine changes, intra- and post-operative complications, duration of procedures. For multivariate statistical analysis we used the Chi-square test. In 83 procedures clamping of the main renal artery was performed (in no case was selective clamping performed). Median value for duration of clamping was 16 minuts. In patients who have undergone ischemia, the duration of ischemia is correlated with the increase in postoperative creatinine (p < 0.001). There was a significant difference in the duration of the procedures between the two groups: group A (median value 90'), group B (median value 120') (p < 0.001) while no difference regarding perioperative complications (p = 0.34) or PSMs (p = 0.73). Both the on-clamp and off-clamp approaches are considered safe and feasible, provided there is adequate surgical experience. The complication rate was similar, as were the oncological outcomes and but post-operative creatinine increases proportionally to the duration of ischemia. In on-clamp procedures the increase in postoperative creatinine is directly related to the duration of ischemia. The off-clamp procedure is shorter with no difference in surgical and oncological outcomes.
To develop and externally validate a prognostic nomogram for overall survival (OS) in resected duodenal adenocarcinoma (DA) using routinely available perioperative variables, thereby clarifying risk profiles and supporting clinical management. Multicenter analysis of 2,289 consecutive DA patients undergoing curative surgery (2012-2022) from China's National Cancer Center database. External validation used 335 patients from Zhejiang Provincial People's Hospital (2022-2024). LASSO-Cox regression selected variables from 89 perioperative factors to construct the nomogram, with web tool implementation. The LASSO-Cox model achieved 1-, 3-, and 5-year AUCs of 0.72 (95% CI 0.68-0.77), 0.75 (95% CI 0.72-0.77), and 0.76 (95% CI 0.73-0.79), outperforming traditional Cox models (P < 0.01). External validation yielded AUCs of 0.76 (95% CI 0.66-0.86) and 0.79 (95% CI 0.74-0.86) for 1- and 3-year OS, and 0.81 (95% CI 0.74-0.89) for estimated 5-year OS. The model stratified patients into low- and high-risk groups (cutoff 0.40), with low-risk patients showing superior survival. Eight predictors were selected, including modifiable surgical factors such as transfusion and operative time. We developed and externally validated a postoperative prognostic nomogram for DA using routinely available perioperative variables. In the present study, the model improved postoperative risk stratification and may support counseling, follow-up planning, and multidisciplinary discussion regarding adjuvant therapy; however, it should be viewed as complementary to standard staging and clinical judgment, and broader clinical implementation will require further validation.
Acute left-sided malignant large bowel obstruction represents a high-risk surgical emergency, frequently associated with significant morbidity, the need for stoma formation, and increased perioperative complications. The use of self-expanding metallic stents (SEMS) as a bridge to surgery has gained prominence as it allows decompression of the obstructed bowel, patient stabilisation, and conversion to a planned elective procedure. This systematic review included seven studies (four randomised controlled trials and three observational cohorts; total n = 819) comparing SEMS as a bridge to surgery with emergency resection. Across the evidence included, SEMS was consistently associated with lower rates of stoma formation and improved facilitation of elective surgery, while short-term morbidity and mortality remained comparable between the two approaches. Stent-related complications, including perforation, were relatively uncommon and largely dependent on operator expertise. Long-term oncological outcomes, including overall survival and disease-free survival, were similar between SEMS and emergency surgery groups, suggesting that the use of SEMS does not adversely affect cancer-related outcomes. Functional benefits, such as effective bowel decompression and improved perioperative optimisation, were more evident in the SEMS group, particularly among elderly patients and those with significant comorbidities. Despite variability in study design and outcome reporting, the overall body of evidence supports SEMS as a safe and effective bridge-to-surgery strategy. It offers meaningful short-term clinical advantages without compromising long-term oncological safety in appropriately selected patients with left-sided malignant large bowel obstruction.
It is common to perform a splenectomy for patients with sickle cell disease (SCD); however, our understanding of its impact on long-term clinical outcomes remains incomplete. To evaluate the clinical outcomes of splenectomy in SCD patients and to assess perioperative physician practices. This is a retrospective cross-sectional study that involved 245 adult Saudi patients with SCD, categorized into two groups: 40 patients who underwent splenectomy and 205 who did not. Data were gathered by structured interviews and electronic health records, including sociodemographic information, features of SCD, surgical procedures, and post-splenectomy outcomes. The splenectomy group exhibited an increased frequency of acute chest syndrome (40% vs. 8.3%) and annual hospital admissions (8.7 vs. 3.35) due to pain crises before splenectomy. Following splenectomy, they demonstrated a notable decrease in hospital admissions and the need for blood transfusions (92.5% vs. 97.1%, 82.5% vs. 84.9%, respectively). Nevertheless, they exhibited a greater prevalence of stroke, venous thrombosis, and acute chest syndrome compared to the non-splenectomy group (15% vs. 2.4%, 12.5% vs. 2.9%, and 45% vs. 8.3%). Patients aged ≤ 33 years (p = 0.03) and those with comorbidities (p = 0.02) demonstrated a significant response to splenectomy. Splenectomy in SCD patients may result in reduced hospital admissions and blood transfusion needs. Yet, it may elevate the risk of thromboembolic events and acute chest syndrome. Optimizing outcomes require careful patient selection and perioperative management.