What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary Artery Bypass Grafting (CABG) (n=4915). Intervention: Postoperative thrombocytopenia vs. Non-thrombocytopenia. Primary outcome: 28-day mortality (OR 0.75, 95% CI 0.33-1.72, p=0.496).

September 17, 2021Open Access

Association Between Postoperative Thrombocytopenia and Outcomes After Coronary Artery Bypass Grafting Surgery

JLJinghang LiCentral South University DYDongmin YuGanzhou People's Hospital YSYuanyuan SongDalian Ocean University

Key Result

Postoperative thrombocytopenia was not significantly associated with increased 28-day mortality (OR 0.75) or in-hospital mortality after adjusting for confounders among CABG patients.

Study Design

Type

Cohort (n=4,915)

Multicenter

Structured PICO

Does postoperative thrombocytopenia increase mortality and adverse outcomes in adult patients undergoing CABG?

Population

4,915 adult patients who underwent isolated coronary artery bypass grafting surgery, evaluated retrospectively to determine the impact of postoperative thrombocytopenia on clinical outcomes.

Exposure

Postoperative thrombocytopenia (platelet count <100 × 10^9/L on the first day after CABG surgery)

Comparator

No postoperative thrombocytopenia

Outcome

28-day mortality and in-hospital mortalityhard clinical

Postoperative thrombocytopenia after CABG is associated with increased morbidity such as prolonged ICU stay and mechanical ventilation, but not with increased short-term mortality.

Main Result

Odds Ratio: 0.75 (95% CI 0.33–1.72)

Absolute Event Rate: 3% vs 1.2%

p-value: p=0.496

Limitations

Retrospective study based on a public database (MIMIC-III), lacking data on perioperative antiplatelet drug use, types of CABG procedures, and perioperative blood transfusion
Single-center study, meaning surgical practices and perioperative management may differ from other institutions
Only the impact of platelet count was studied, without considering the influence of platelet function abnormalities

Abstract

Objectives: The effect of postoperative thrombocytopenia on adverse events among coronary artery bypass graft (CABG) patients remains unclear. This study aims to investigate the association between postoperative thrombocytopenia and perioperative outcomes of CABG. Methods: This is a retrospective study with MIMIC-III (Medical Information Mart for Intensive Care III) database. Adult patients who underwent CABG were included to analyze the impact of thrombocytopenia in patients' outcomes. Postoperative thrombocytopenia was defined as a platelet count 100 × 10 9 /L on the first day after CABG surgery. A multivariable logistic regression analysis was utilized to adjust the effect of thrombocytopenia on outcomes for baseline and covariates, and to determine the association with outcomes. Results: A total of 4,915 patients were included, and postoperative thrombocytopenia occurred in 696 (14.2%) patients. Postoperative thrombocytopenia was not associated with increased 28-day mortality (OR 0.75; 95% CI 0.33–1.72; P = 0.496) or in-hospital mortality (OR 0.75; 95% CI 0.34–1.63; P = 0.463) after adjusting for confounders. Regarding the secondary outcomes, it was associated with a higher risk of a prolonged stay in the intensive care unit (OR 1.53; 95% CI 1.18–1.97; P = 0.001), prolonged hospital stays (OR 1.58; 95% CI 1.21–2.06; P = 0.001), prolonged mechanical ventilation time (OR 1.67; 95% CI 1.14–2.44; P = 0.009), and a trend toward increased occurrence of massive bleeding (OR 1.41; 95% CI 1.00–2.01; P = 0.054). There was no significant association between an increased risk of prolonged vasopressor use and the continuous renal replacement therapy rate. Conclusions: Postoperative thrombocytopenia was associated with prolonged ICU and hospital stays but not with increased perioperative mortality among CABG patients.

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