Predictive Factors for Successful Laparoscopic Splenectomy in Patients With Immune Thrombocytopenic Purpura

HYPOTHESIS: Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS). DESIGN: Case series. SETTING: Private, tertiary care referral center. PATIENTS: Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001. INTERVENTIONS: Laparoscopic splenectomy. MAIN OUTCOME MEASURES: A successful response to LS was defined as a postoperative platelet count greater than 100 x 10(3)/microL without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 x 10(3)/microL without medical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 x 10(3)/microL, but thrombocytopenia subsequently recurred. RESULTS: Both univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P =.005) and had a higher preoperative platelet count (P =.005). In multivariate analysis, younger age (P =.005) and a higher preoperative platelet count (P =.007) again predicted a successful response to LS. CONCLUSIONS: A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 10(3)/microL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.