Thrombocytopenia and craniotomy for tumor: A National Surgical Quality Improvement Program analysis.

Abstract

BACKGROUND:

To the authors' knowledge, the current study is the first national analysis of the association between preoperative platelet count and outcomes after craniotomy.

METHODS:

Patients who underwent craniotomy for tumor were extracted from the prospective National Surgical Quality Improvement Program registry (2007-2014) and stratified by preoperative thrombocytopenia, defined as mild (125,000-149,000/μL), moderate (100,000-124,000/μL), severe (75,000-99,000/μL), or very severe (<75,000/μL). Cox proportional hazards analysis was used to evaluate the association between thrombocytopenia and 30-day mortality, and multivariable logistic regression with complications and unplanned reoperation. Covariates included patient age, sex, tumor histology, American Society of Anesthesiologists class, functional status, comorbidities, and surgical time.

RESULTS:

A total of 14,852 patients were included in the current study and thrombocytopenia was classified as mild in 4.4% (646 patients), moderate in 2.0% (290 patients), severe in 0.7% (105 patients), or very severe in 0.4% (66 patients) of patients. The adjusted hazard of 30-day death was significantly higher for patients with moderate (6.6%; hazard ratio [HR], 2.13 [95% confidence interval (95% CI), 1.30-3.49; P =  0.003]), severe (10.5%; HR, 2.33 [95% CI, 1.18-4.60; P =  0.02]), and very severe (10.6%; HR, 3.65 [95% CI, 1.71-7.82; P =  0.001]) thrombocytopenia, compared with patients without thrombocytopenia (2.9%), with an increased effect size noted with greater thrombocytopenia. Likewise, when the platelet count was evaluated continuously, a higher platelet count was associated with a lower hazard of 30-day mortality (HR, 0.987 [95% CI, 0.981-0.993; P<.001]), developing any complication (odds ratio, 0.985 [95% CI, 0.981-0.988; P<.001]), and reoperation (odds ratio, 0.990 [95% CI, 0.983-0.994; P = .003]). Unplanned reoperation was due to intracranial hemorrhage in 53.3% of patients with moderate thrombocytopenia.

CONCLUSIONS:

In this National Surgical Quality Improvement Program analysis, moderate and severe thrombocytopenia were associated with mortality and reoperation after craniotomy for tumor. Cancer 2016;122:1708-17. © 2016 American Cancer Society.

• Authors: Hormuzdiyar H Dasenbrock, Christopher A Devine, Kevin X Liu, William B Gormley, Elizabeth B Claus, Timothy R Smith, Ian F Dunn
• Journal: Cancer (Cancer) Vol. 122 Issue 11 Pg. 1708-17 (Jun 01 2016) ISSN: 1097-0142 [Electronic] United States
• PMID: 26990185 (Publication Type: Journal Article)
• Copyright: © 2016 American Cancer Society.

Topics

• Adult
• Aged
• Brain Neoplasms (blood, mortality, surgery)
• Confidence Intervals
• Craniotomy (mortality, standards)
• Databases, Factual
• Female
• Humans
• Intracranial Hemorrhages (surgery)
• Logistic Models
• Male
• Middle Aged
• Platelet Count
• Postoperative Complications (surgery)
• Preoperative Period
• Program Evaluation
• Proportional Hazards Models
• Quality Improvement
• Registries (statistics & numerical data)
• Reoperation (statistics & numerical data)
• Thrombocytopenia (classification, complications, diagnosis, mortality)
• Treatment Outcome
• Young Adult