Key result
Preoperative platelet count abnormalities, including all levels of thrombocytopenia and thrombocytosis, were associated with increased odds of perioperative erythrocyte transfusion compared to normal platelet counts.
Why the study?
While coagulation tests such as platelet count are frequently used to identify bleeding risk in non-cardiac surgery, findings regarding their effect on outcomes have been equivocal.
Does pre-operative platelet count abnormality increase the risk of perioperative transfusion and adverse outcomes in adult patients undergoing elective, non-cardiac surgery?
Cohort (n=3,884,400)
Yes
Does pre-operative platelet count abnormality increase the risk of perioperative transfusion and adverse outcomes in adult patients undergoing elective, non-cardiac surgery?
Odds Ratio: 1.2 (95% CI 1.1–1.2)
Absolute Event Rate: 9.1% vs 4.8%
Pre-operative thrombocytopenia is independently associated with increased odds of perioperative transfusion and 30-day mortality in elective non-cardiac surgery, highlighting the utility of routine platelet screening.
Abnormal preoperative platelet counts may flag higher transfusion risk in elective non-cardiac surgery; leaves open whether screening improves outcomes.
BACKGROUND: Anemia and transfusion of blood in the peri-operative period have been shown to be associated with increased morbidity and mortality across a wide variety of non-cardiac surgeries. While tests of coagulation, including the platelet count, have frequently been used to identify patients with an increased risk of peri-operative bleeding, results have been equivocal. The aim of this study was to assess the effect of platelet level on outcomes in patients undergoing elective surgery. MATERIALS AND METHODS: Retrospective cohort analysis of prospectively-collected clinical data from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between 2006-2016. RESULTS: We identified 3,884,400 adult patients who underwent elective, non-cardiac surgery from 2006-2016 at hospitals participating in NSQIP, a prospectively-collected, national clinical database with established reproducibility and validity. After controlling for all peri- and intraoperative factors by matching on propensity scores, patients with all levels of thrombocytopenia or thrombocytosis had higher odds for perioperative transfusion. All levels of thrombocytopenia were associated with higher mortality, but there was no association with complications or other morbidity after matching. On the other hand, thrombocytosis was not associated with mortality; but odds for postoperative complications and 30-day return to the operating room remained slightly increased after matching. CONCLUSIONS: These findings may guide surgeons in the appropriate use and appreciation of the utility of pre-operative screening of the platelet count prior to an elective, non-cardiac surgery.
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Weil et al. (2019) conducted a cohort in Elective, non-cardiac surgery (n=3,884,400). Platelet count abnormalities (thrombocytopenia or thrombocytosis) vs. Normal platelet count (150,000-450,000 platelets/μl) was evaluated on Administration of any erythrocyte (RBC) transfusion (OR 1.2, 95% CI 1.1-1.2). Preoperative platelet count abnormalities, including all levels of thrombocytopenia and thrombocytosis, were associated with increased odds of perioperative erythrocyte transfusion compared to normal platelet counts.
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