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Sayed ME, Zastrow R, Youssef S, Levin AS. Associations of preoperative hematocrit and platelet count with morbidity after pathologic fracture fixation. J Bone Oncol 2025; 52:100679. [PMID: 40276379 PMCID: PMC12020851 DOI: 10.1016/j.jbo.2025.100679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Revised: 03/26/2025] [Accepted: 03/27/2025] [Indexed: 04/26/2025] Open
Abstract
Background Anemia and abnormal platelet count are common among patients with cancer and are associated with complications after orthopaedic procedures. We studied associations between these conditions and morbidity within 30 days after surgery for pathologic femur or humerus fracture. Methods We retrospectively reviewed data from the National Surgery Quality Improvement Project database for 145,030 adults following surgical fixation of a pathologic femur or humerus fracture from 2010 to 2020. Multivariable logistic regressions compared 30-day complications between patients with mild or severe anemia versus those with normal hematocrit and between patients with thrombocytopenia or thrombocytosis versus those with normal platelet count. Results Likelihood of extended hospitalization (≥6 days) was higher in patients with mild anemia (odds ratio [OR]: 1.47; 95 % confidence interval [CI]: 1.44, 1.51) and severe anemia (OR: 2.14; 95 % CI: 2.06, 2.23). Likelihood of all-cause morbidity was also higher among those with mild anemia (OR: 1.17; 95 % CI: 1.13, 1.21) and severe anemia (OR: 1.35; 95 % CI: 1.28, 1.42). Similarly, likelihood of extended hospitalization was higher in patients with thrombocytopenia (OR: 1.25; 95 % CI: 1.22, 1.29) and thrombocytosis (OR: 1.24; 95 % CI: 1.13, 1.36). Likelihood of all-cause morbidity was also higher for those with thrombocytopenia (OR: 1.12; 95 % CI: 1.07, 1.16) and thrombocytosis (OR: 1.21; 95 % CI: 1.07, 1.37). Conclusion Preoperative anemia and platelet abnormalities were potentially modifiable risk factors associated with postoperative complications following surgery for pathologic fracture.
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Affiliation(s)
- Mohyeddine El Sayed
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Ryley Zastrow
- The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Sassine Youssef
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Adam S. Levin
- The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
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2
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Wilcox T, Smilowitz NR, Berger JS. Association between preoperative platelet count and perioperative cardiovascular events after noncardiac surgery. J Thromb Haemost 2025:S1538-7836(25)00261-2. [PMID: 40268273 DOI: 10.1016/j.jtha.2025.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 03/28/2025] [Accepted: 04/08/2025] [Indexed: 04/25/2025]
Abstract
BACKGROUND Platelets are major players in the pathogenesis of cardiovascular events, and the number of circulating platelets in whole blood is routinely available in clinical testing. The relationship between the preoperative platelet count and major adverse cardiovascular events (MACE) after noncardiac surgery is uncertain. OBJECTIVES In this paper we aim to explore the relationship between abnormal platelet counts and major adverse cardiac events (MACE) after noncardiac surgery. METHODS We identified adults aged ≥18 years undergoing noncardiac surgery from 2009 to 2015 from the National Surgical Quality Improvement Program. Preoperative platelet counts within 90 days of surgery were recorded. Patients were prospectively followed for 30 days. The primary outcome was 30-day MACE (a composite of death, myocardial infarction, or stroke). Multivariable logistic regression models estimated the association between platelet count and the odds of postoperative outcomes. RESULTS Among 3 053 308 surgical patients, 7.5% had thrombocytopenia (6% mild [platelet count 100-150 × 109/L] and 1.5% moderate-severe [<100 × 109/L]), and 4.4% had thrombocytosis (4% moderate [400-600 × 109/L] and 0.4% severe [>600 × 109/L]). There was a U-shaped relationship between platelet count and MACE. The adjusted odds of MACE were elevated in mild (adjusted odds ratio [aOR], 1.44; 95% CI, 1.39-1.48) and moderate-severe thrombocytopenia (aOR, 2.79; 95% CI, 2.69-2.90) and in moderate (aOR, 1.57; 95% CI, 1.52-1.63) and severe (aOR, 1.91; 95% CI, 1.74-2.09) thrombocytosis. Findings were consistent for the individual endpoints of death, myocardial infarction, and stroke. CONCLUSION In adults undergoing noncardiac surgery, preoperative thrombocytopenia and thrombocytosis were identified in nearly 12% of cases and were associated with increased odds of cardiovascular events at 30 days.
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Affiliation(s)
- Tanya Wilcox
- The Division of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
| | - Nathaniel R Smilowitz
- The Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA; Cardiology Section, Department of Medicine, Veteran's Association New York Harbor Healthcare System, New York, New York, USA
| | - Jeffrey S Berger
- The Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, New York, USA; Department of Surgery, New York University School of Medicine, New York, New York, USA
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3
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Hussain N, Khan M, Mahmood A, Tipu M, Aslam S. An evaluation of osseous regeneration capability of novel autogenous tooth graft along with orthobiologics for long bone segmental defects. Heliyon 2025; 11:e41932. [PMID: 39897829 PMCID: PMC11787641 DOI: 10.1016/j.heliyon.2025.e41932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/09/2025] [Accepted: 01/12/2025] [Indexed: 02/04/2025] Open
Abstract
Extracted tooth, is predominantly considered a medical waste but tooth and bone evince similitude in biochemical composition, so tooth may be considered as bone graft material. We selected twenty-four adult rabbits with age and body weight ranges of 1-3 years and 2-4 kg respectively, regardless of sex and breed. These rabbits were allocated into four groups i.e., J, K, L, and M. Autogenous tooth graft was acquired from the individual's incisor. In group J (control), tooth graft alone was used at the mid shaft radius fractured site. For group K, tooth and bone marrow aspirate (BMA) were applied. In group L, tooth-platelet rich plasma (PRP) was administered while for group M, tooth-decellularized fish scale (DFS) was engrafted at the location. The research was conducted for 4 months and parameter evaluation was done on 0, 1st, 7th, 15th, 30th, 45th, 60th, 75th, 90th, 105th and 120th days. The therapeutic regimens were extensively appraised in terms of physiological vitals, hematology, serology, bone biomarkers, mechanical assessment, radiography and histomorphometric parameters. We noticed appropriate osteointegration of autologous tooth with the fractured site, good healing and bone remodeling in all groups with superior to lower trends in Tooth-BMA, Tooth-PRP, Tooth-DFS, and Tooth-solo groups respectively. Though usage of aforementioned regimens in-vivo needs further trials but overall, we may suggest that autogenous tooth is not only a novel and viable graft in solo but its healing capacity, osteointegration and firm callus formation can be augmented with appropriate orthobiologic materials and in future may be useful for bone defect treatments, not only in animals but humans as well.
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Affiliation(s)
- N. Hussain
- Department of Veterinary Surgery, University of Veterinary and Animal Sciences Lahore, 54000, Pakistan
| | - M.A. Khan
- Department of Veterinary Surgery, University of Veterinary and Animal Sciences Lahore, 54000, Pakistan
| | - A.K. Mahmood
- Department of Small Animal Clinical Sciences, University of Veterinary and Animal Sciences Lahore, 54000, Pakistan
| | - M.Y. Tipu
- Department of Pathology, University of Veterinary and Animal Sciences Lahore, 54000, Pakistan
| | - S. Aslam
- Department of Veterinary Surgery, University of Veterinary and Animal Sciences Lahore, 54000, Pakistan
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Chungsaengsatitayaporn S, Pipanmekaporn T, Khorana J, Leurcharusmee P, Boonsri S, Siriphuwanun V. Predictive Factors for 24-h Survival After Perioperative Cardiopulmonary Resuscitation: Single-Center Retrospective Cohort Study. J Clin Med 2025; 14:599. [PMID: 39860605 PMCID: PMC11766343 DOI: 10.3390/jcm14020599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/12/2025] [Accepted: 01/14/2025] [Indexed: 01/27/2025] Open
Abstract
Background: Perioperative cardiac arrest (POCA) remains a major challenge in surgical settings, with low survival after cardiopulmonary resuscitation (CPR). This study aims to identify predictive factors for 24 h survival after CPR and cause of POCA. Method: A retrospective, single-center study was conducted on patients aged ≥18 years who experienced POCA and received CPR in the operating room or within 2 h postoperatively at Chiang Mai University Hospital from 2010 to 2019. The multivariable analysis of independent survival predictors was performed using risk regression models. Results: There were 288 cases of cardiopulmonary arrest requiring CPR, with 61 patients surviving. Significant predictors of survival after perioperative CPR included the American Society of Anesthesiologists physical status classification (ASA) 1-2 (RR 2.53; 95%CI 1.69-3.77; p < 0.001), preoperative hemoglobin ≥ 8 g/dL (RR 2.27; 95%CI 1.05-4.89; p = 0.036), preoperative oxygen saturation ≥ 90% (spontaneous breathing in room air) (RR 3.19; 95%CI 1.21-8.41; p = 0.019), initial end-tidal carbon dioxide between 35 and 45 mmHg (RR 1.55; 95%CI 0.98-2.44; p = 0.059), and duration of CPR ≤ 30 min (RR 3.68; 95%CI 1.51-8.98; p = 0.004). The major cause of POCA was hypovolemia (74.30%). Conclusions: This study identifies several critical predictors for 24 h survival following POCA, which can inform pre-operative optimization and perioperative management. Timely interventions, such as blood transfusions and volume resuscitation, are crucial in improving survival outcomes, particularly in trauma and high-risk patients. Further multi-center studies are needed to validate these findings and explore long-term outcomes to refine perioperative cardiac arrest management.
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Affiliation(s)
- Soontarin Chungsaengsatitayaporn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Intavarorote Rd., Muang Chiang Mai District, Chiang Mai 50200, Thailand; (S.C.); (P.L.); (S.B.); (V.S.)
| | - Tanyong Pipanmekaporn
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Intavarorote Rd., Muang Chiang Mai District, Chiang Mai 50200, Thailand; (S.C.); (P.L.); (S.B.); (V.S.)
- Department of Biomedical Informatics and Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Jiraporn Khorana
- Department of Biomedical Informatics and Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Prangmalee Leurcharusmee
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Intavarorote Rd., Muang Chiang Mai District, Chiang Mai 50200, Thailand; (S.C.); (P.L.); (S.B.); (V.S.)
| | - Settapong Boonsri
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Intavarorote Rd., Muang Chiang Mai District, Chiang Mai 50200, Thailand; (S.C.); (P.L.); (S.B.); (V.S.)
| | - Visith Siriphuwanun
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Intavarorote Rd., Muang Chiang Mai District, Chiang Mai 50200, Thailand; (S.C.); (P.L.); (S.B.); (V.S.)
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Fisher A, Fisher L, Srikusalanukul W. Prediction of Osteoporotic Hip Fracture Outcome: Comparative Accuracy of 27 Immune-Inflammatory-Metabolic Markers and Related Conceptual Issues. J Clin Med 2024; 13:3969. [PMID: 38999533 PMCID: PMC11242639 DOI: 10.3390/jcm13133969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/26/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Objectives: This study, based on the concept of immuno-inflammatory-metabolic (IIM) dysregulation, investigated and compared the prognostic impact of 27 indices at admission for prediction of postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In consecutive HF patient (n = 1273, mean age 82.9 ± 8.7 years, 73.5% females) demographics, medical history, laboratory parameters, and outcomes were recorded prospectively. Multiple logistic regression and receiver-operating characteristic analyses (the area under the curve, AUC) were used to establish the predictive role for each biomarker. Results: Among 27 IIM biomarkers, 10 indices were significantly associated with development of PMI and 16 were indicative of a fatal outcome; in the subset of patients aged >80 years with ischaemic heart disease (IHD, the highest risk group: 90.2% of all deaths), the corresponding figures were 26 and 20. In the latter group, the five strongest preoperative predictors for PMI were anaemia (AUC 0.7879), monocyte/eosinophil ratio > 13.0 (AUC 0.7814), neutrophil/lymphocyte ratio > 7.5 (AUC 0.7784), eosinophil count < 1.1 × 109/L (AUC 0.7780), and neutrophil/albumin × 10 > 2.4 (AUC 0.7732); additionally, sensitivity was 83.1-75.4% and specificity was 82.1-75.0%. The highest predictors of in-hospital death were platelet/lymphocyte ratio > 280.0 (AUC 0.8390), lymphocyte/monocyte ratio < 1.1 (AUC 0.8375), albumin < 33 g/L (AUC 0.7889), red cell distribution width > 14.5% (AUC 0.7739), and anaemia (AUC 0.7604), sensitivity 88.2% and above, and specificity 85.1-79.3%. Internal validation confirmed the predictive value of the models. Conclusions: Comparison of 27 IIM indices in HF patients identified several simple, widely available, and inexpensive parameters highly predictive for PMI and/or in-hospital death. The applicability of IIM biomarkers to diagnose and predict risks for chronic diseases, including OP/OF, in the preclinical stages is discussed.
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Affiliation(s)
- Alexander Fisher
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Department of Orthopaedic Surgery, The Canberra Hospital, ACT Health, Canberra 2605, Australia
- Medical School, Australian National University, Canberra 2601, Australia
| | - Leon Fisher
- Frankston Hospital, Peninsula Health, Melbourne 3199, Australia
| | - Wichat Srikusalanukul
- Department of Geriatric Medicine, The Canberra Hospital, ACT Health, Canberra 2605, Australia
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Gładysz-Wańha S, Joniec M, Wańha W, Piłat E, Drzewiecka A, Gardas R, Biernat J, Węglarzy A, Gołba KS. Transvenous lead extraction safety and efficacy in infected and noninfected patients using mechanical-only tools: Prospective registry from a high-volume center. Heart Rhythm 2024; 21:427-435. [PMID: 38157921 DOI: 10.1016/j.hrthm.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Transvenous lead extraction (TLE) is a well-established treatment option for patients with cardiac implantable electronic devices (CIED) complications. OBJECTIVE The purpose of this study was to evaluate the safety and efficacy of TLE in CIED infection and non-CIED infection patients. METHODS Consecutive patients who underwent TLE between 2016 and 2022 entered the EXTRACT Registry. Models of prediction were constructed for periprocedural clinical and procedural success and the incidence of major complications, including death in 30 days. RESULTS The registry enrolled 504 patients (mean age 66.6 ± 12.8 years; 65.7% male). Complete procedural success was achieved in 474 patients (94.0%) and clinical success in 492 patients (97.6%). The total number of major and minor complications was 16 (3.2%) and 51 (10%), respectively. Three patients (0.6%) died during the procedure. New York Heart Association functional class IV and C-reactive protein levels defined before the procedure were independent predictors of any major complication, including death in 30 days in CIED infection patients. The time since the last preceding procedure and platelet count before the procedure were independent predictors of any major complication, including death in 30 days in non-CIED infection patients. CONCLUSIONS TLE is safe and successfully performed in most patients, with a low major complication rate. CIED infection patients demonstrate better periprocedural clinical success and complete procedural success. However, CIED infection predicts higher 30-day mortality compared with non-CIED infection patients. Predictors of any major complication, including death in 30 days, differ between CIED infection and non-CIED infection patients.
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Affiliation(s)
- Sylwia Gładysz-Wańha
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland; Doctoral School of the Medical University of Silesia in Katowice, Poland.
| | - Michał Joniec
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland; Doctoral School of the Medical University of Silesia in Katowice, Poland
| | - Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Eugeniusz Piłat
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Anna Drzewiecka
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Rafał Gardas
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Andrzej Węglarzy
- Department of Anaesthesiology and Intensive Care with Cardiac Supervision, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland
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7
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Liu SH, Ling K, Loyst RA, Al-Humadi S, Komatsu DE, Wang ED. Preoperative thrombocytopenia and thrombocytosis predict complications after arthroscopic rotator cuff repair. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:48-52. [PMID: 38323198 PMCID: PMC10840563 DOI: 10.1016/j.xrrt.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background The purpose of this study was to investigate the association between preoperative platelet count and 30-day postoperative complications following arthroscopic rotator cuff repair (aRCR). Methods The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent aRCR between 2015 and 2021. The study population was divided into 5 groups based on preoperative platelet count: normal (200-450k, reference cohort), low-normal (150-200k), mild thrombocytopenia (100-150k), moderate-to-severe thrombocytopenia (<100k), and thrombocytosis (>450k). Thirty-day postoperative complications following aRCR were collected. Multivariate logistic regression analysis was conducted to investigate the relationship between preoperative platelet counts and postoperative complications. Results 24,779 patients were included in this study: 18,697 (75.5%) in the normal group, 4730 (19.1%) in the low-normal group, 1012 (4.1%) in the mild thrombocytopenia group, 171 (0.7%) in the moderate-to-severe thrombocytopenia group, and 169 (0.7%) in the thrombocytosis group. Low-normal platelets were an independent predictor of urinary tract infection (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.12-3.77; P = .020). Mild thrombocytopenia was not an independent predictor of any complications. Moderate-to-severe thrombocytopenia was an independent predictor of sepsis (OR 9.39, 95% CI 1.48-59.47; P = .017), pneumonia (OR 6.62, 95% CI 1.32-33.24; P = .022), and nonhome discharge (OR 3.34, 95% CI 1.20-9.25; P = .021). Thrombocytosis was an independent predictor of urinary tract infection (OR 4.91, 95% CI 1.16-20.78; P = .030). Conclusion Abnormal preoperative platelet counts, both low and high, were independent risk factors for 30-day postoperative complications following aRCR.
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Affiliation(s)
- Steven H. Liu
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Rachel A. Loyst
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Samer Al-Humadi
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics, Stony Brook University, Stony Brook, NY, USA
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Liu Y, Liu H, Zhang F. Development and Internal Validation of a Nomogram for Predicting Postoperative Cardiac Events in Elderly Hip Fracture Patients. Clin Interv Aging 2023; 18:2063-2078. [PMID: 38107187 PMCID: PMC10725632 DOI: 10.2147/cia.s435264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Postoperative cardiac events (PCEs) are among the main adverse events after hip fracture surgery in the elderly. Existing cardiac risk assessment tools have some limitations and are not specifically designed for elderly patients undergoing hip fracture surgery. This study aimed to develop and internally validate a nomogram for prediction of PCEs in these patients. Patients and Methods We performed a retrospective study of 992 patients aged ≥65 years undergoing hip fracture surgery in our hospital from July 2015 to December 2021. Patients' demographics and clinical data were collected. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select predictors, and multivariate logistic regression was employed to construct a nomogram. Internal validation was performed by bootstrapping. The discriminatory ability of the model was determined by the area under the receiver operating characteristic curve (AUC). The calibration and clinical utility of the model were assessed. The predictive power and clinical benefit of the nomogram were compared with the Revised Cardiac Risk Index (RCRI). Results The nomogram was constructed including seven variables: general anesthesia, the American Society of Anesthesiologists (ASA) classification, history of heart failure, history of severe arrhythmia, history of coronary artery disease, preoperative platelet count, and serum creatinine. The nomogram had an excellent predictive ability (AUC = 0.875, 95% confidence interval [CI]: 0.828-0.918). Satisfactory calibration was shown by calibration plots and the Hosmer-Lemeshow goodness-of-fit test (P = 0.520). Clinical usefulness was confirmed by decision curve analysis and clinical impact curve. The predictive power and clinical utility of the nomogram were superior to RCRI. Conclusion We developed an easy-to-use nomogram for prediction of PCEs in elderly hip fracture patients. This prediction model could effectively identify patients at high risk of PCEs and may be useful for perioperative management optimization.
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Affiliation(s)
- Yuanmei Liu
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Huilin Liu
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
| | - Fuchun Zhang
- Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China
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Mumtaz H, Danish R, Yousaf T, Sehgal S, Jawad A, Ali Haider SM. Frequency and Outcome of Pregnant Females Presenting With Thrombocytopenia at a Tertiary Care Hospital. Cureus 2023; 15:e49466. [PMID: 38152787 PMCID: PMC10751517 DOI: 10.7759/cureus.49466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Platelet-related problems are more frequently discovered in women during pregnancy because screening is carried out as part of the initial clinic examination using automated blood counts. This study was done to find out the frequency and outcomes of pregnant females presenting with thrombocytopenia at a tertiary care hospital. METHODOLOGY This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore, Pakistan, from April 2023 to September 2023. This study involved 280 pregnant women presenting in the third trimester. Blood examination was acquired, and a platelet count less than 150x109/L was labeled as thrombocytopenia. Outcome variables were frequency of thrombocytopenia, while post-delivery, frequency of placental abruption, preterm delivery, stillbirth, need for blood transfusion, and poor Apgar score were noted and compared among women with and without thrombocytopenia. RESULTS In a total of 280 pregnant females, the mean age and gestational age at the time of presentation were 29.34±4.38 years and 31.30±2.87 weeks, respectively. The mean BMI of the females was 27.97±4.72 kg/m2. Thrombocytopenia was noted in 34 females (12.1%). Placental abruption, preterm delivery, need for blood transfusion, stillbirth, and poor Apgar score were observed in 1.4%, 4.3%, 8.2%, 1.1%, and 2.1% cases, respectively. Placental abruption (11.8% vs. 0.0%; p<0.001), preterm delivery (29.4% vs. 0.8%; p<0.001), need of blood transfusion (35.3% vs. 4.5%; p<0.001), stillbirth (8.8% vs. 0.0%; p<0.001), and poor Apgar score (17.6% vs. 0.0%; p<0.001) were all significantly higher among pregnant women with thrombocytopenia as compared to those with a normal platelet count. CONCLUSION The frequency of thrombocytopenia was 12.1% among pregnant females. The frequency of placental abruption, preterm delivery, need for blood transfusion, stillbirth, and poor Apgar score were all significantly higher among pregnant women with thrombocytopenia as compared to those with a normal platelet count, irrespective of the patient's age, parity, and BMI.
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Affiliation(s)
- Hira Mumtaz
- Gynaecology and Obstetrics, Basildon University Hospital, National Health Service (NHS) Trust, Basildon, GBR
| | | | - Tayiba Yousaf
- Obstetrics and Gynecology, Salma Khalil Clinic, Narowal, PAK
| | - Shazia Sehgal
- Obstetrics and Gynecology, Fatima Jinnah Medical University, Lahore, PAK
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Kim M, Ling K, Nazemi A, Tantone R, Kashanchi K, Lung B, Komatsu DE, Wang ED. Abnormal Preoperative Platelet Count May Predict Postoperative Complications Following Shoulder Arthroplasty. JSES Int 2022; 6:935-941. [PMID: 36353411 PMCID: PMC9637646 DOI: 10.1016/j.jseint.2022.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this study is to investigate the association between preoperative platelet counts and postoperative complication rates within 30 days of total shoulder arthroplasty (TSA). Methods The American College of Surgeons National Surgical Quality Improvement database was queried for all patients who underwent TSA between 2015 and 2019. The study population was then divided into 5 groups based on their preoperative platelet count: <100k (moderate-to-severe thrombocytopenia), 100-150k (mild thrombocytopenia), 150-200k (low-normal preoperative platelet count), 200-450k (normal, reference cohort), and >450k (thrombocytosis). Postoperative complications within 30 days of the TSA were collected. Multivariate logistic regression analysis was conducted to investigate the relationship between preoperative platelet counts and postoperative complications. Results A total of 19,721 patients undergoing TSA between 2015 and 2019 were included in this study. One hundred fifty-five patients (0.8%) had moderate-to-severe thrombocytopenia, 982 (5.0%) had mild thrombocytopenia, 3945 (20.0%) had a low-normal preoperative platelet count, 14,386 (72.9%) had a normal preoperative platelet count, and 253 (1.3%) had thrombocytosis. An increasing rate of overall complications was observed as the severity of thrombocytopenia progressed from low-normal (6.4%) to mild thrombocytopenia (10.2%) and to moderate-to-severe thrombocytopenia (18.7%). The overall complication rate of the thrombocytosis cohort was 14.6%. In comparison to normal platelet count, low-normal thrombocytopenia, mild thrombocytopenia, moderate-to-severe thrombocytopenia, and thrombocytosis were identified by multivariate analysis as significant predictors of overall complications (odds ratios [ORs] of 1.12, 2.15, 2.43, 2.71, respectively), postoperative anemia requiring transfusion (ORs of 1.63, 3.45, 5.97, 4.21, respectively), and minor complications (ORs of 1.39, 2.64, 3.40, 3.34, respectively). Minor complications include progressive renal insufficiency, urinary tract infection, transfusions within 72 hours after surgery, pneumonia, and superficial incisional surgical site infection. Conclusion Increasing severity of thrombocytopenia correlated with higher overall postoperative complication rates following TSA. Interestingly, patients with thrombocytosis had the highest overall postoperative complication rates among all cohorts included in this study. Platelet counts are often the reflection of other comorbidities and a good indicator of patient's general health status. Long-term optimization of abnormal platelet counts may potentially reduce surgical complications.
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Affiliation(s)
- Matthew Kim
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Kenny Ling
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Alireza Nazemi
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Ryan Tantone
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Kevin Kashanchi
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Brandon Lung
- Department of Orthopaedics, UCI, Orange, CA, USA
| | - David E. Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D. Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
- Corresponding author: Edward D. Wang, MD, Department of Orthopaedics and Rehabilitation, Stony Brook University Hospital, HSC T-18, Room 080, Stony Brook, NY 11794-8181, USA.
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Matzek LJ, Kurian EB, Frank RD, Weister TJ, Gajic O, Kor DJ, Warner MA. Plasma, platelet and red blood cell transfusion ratios for life-threatening non-traumatic haemorrhage in medical and post-surgical patients: An observational study. Vox Sang 2022; 117:361-370. [PMID: 34337749 PMCID: PMC8803985 DOI: 10.1111/vox.13188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the broad utilization of component-based transfusion strategies that aim to reconstitute whole blood during acute traumatic haemorrhage, data for haemorrhage occurring outside of trauma and surgery are limited. METHODS This is an observational cohort study of adults experiencing critical non-traumatic, non-intraoperative haemorrhage during hospitalization at an academic medical centre from 2011 to 2015. The primary goal was to evaluate differences in plasma and platelet to red blood cell (RBC) transfusion ratios across patient demographic, clinical and laboratory characteristics. Secondarily, associations between transfusion ratios and clinical outcomes were assessed. RESULTS Seven hundred nine patients were included: 498 (70.2%) medical and 211 (29.8%) post surgical. The gastrointestinal tract (36.7%) was the most common site of bleeding. Most patients received RBCs without plasma (35.5%) or platelets (54.2%). Among those receiving plasma, 82.3% received a plasma to RBC ratio < 1:1 at 24 h. For platelets, the most common ratio was 1-2:1 (52.9%). Transfusion ratios were generally consistent across comorbid disease severity, admission type and anatomic sites of bleeding. Higher plasma utilization was observed in the emergency department, while greater platelet utilization occurred in intensive care units. Higher transfusion ratios were observed in those with greater laboratory haemostatic abnormalities prior to the haemorrhagic event. Clinical outcome differences were limited, though greater platelet utilization in the first 24 h was associated with higher mortality and fewer hospital-free days. CONCLUSIONS Transfusion ratios for critical non-traumatic haemorrhage were primarily related to laboratory abnormalities preceding the haemorrhagic event and practice environments. Clinical outcome differences across ratios were limited.
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Affiliation(s)
- Luke J. Matzek
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Emil B. Kurian
- Mayo Clinic Alix School of Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Ryan D. Frank
- Department of Biomedical Statistics and Informatics, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Timothy J. Weister
- Department of Biomedical Statistics and Informatics, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Ognjen Gajic
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Daryl J. Kor
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN,Patient Blood Management Program, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Matthew A. Warner
- Patient Blood Management Program, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN,Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
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12
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Li J, Yu D, Song Y, Cheang I, Wang X. Association Between Postoperative Thrombocytopenia and Outcomes After Coronary Artery Bypass Grafting Surgery. Front Surg 2021; 8:747986. [PMID: 34604298 PMCID: PMC8484630 DOI: 10.3389/fsurg.2021.747986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
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 × 109/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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Affiliation(s)
- Jinghang Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dongmin Yu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanyuan Song
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Beurton A, Ferté T, Mion S, Besnard T, Jecker O, Remy A, Labrousse L, Ouattara A. Risk Factors of Midterm Mortality After Aortic Valve Replacement for Severe Calcified Tricuspid Aortic Valve Stenosis: A retrospective analysis of Perioperative Events Assessment in Adult Cardiac surgery (PESSAC) Registry. J Cardiothorac Vasc Anesth 2021; 35:3547-3556. [PMID: 34503891 DOI: 10.1053/j.jvca.2021.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) initially developed for predicting early postoperative mortality of all types of cardiac surgery, is less able to predict, more specifically, long-term outcomes after aortic valve replacement (AVR). The study authors here evaluated the risk factors for three-year mortality after isolated aortic valve replacement (AVR) for severe calcified tricuspid aortic valve stenosis and compared them with EuroSCORE II to predict long-term outcomes. DESIGN A retrospective study. SETTING A university teaching hospital. PARTICIPANTS This study included 1,101 adults who underwent isolated AVR for severe calcified tricuspid aortic valve stenosis between September 2010 to June 2015. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary endpoint was that of three-year all-cause mortality after AVR. By three years, 168 patients (15.3%) had died. Risk factors for all-cause mortality were: male gender (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.21-2.62; p < 0.01), peripheral arterial disease (OR = 1.77; 95% CI = 1.08-2.92; p = 0.03), age (OR = 1.06 per year increase; 95% CI =1.04-1.09; p < 0.01), pulmonary artery systolic pressure (OR = 1.02 per mmHg increase; 95% CI = 1.01-1.03; p < 0.01), platelet count (OR = 1.003 per G/L increase; 95% CI = 1.000-1.005; p = 0.04), and valve area (OR = 0.97 per cm²/m² increase; 95% CI= 0.95-0.99; p < 0.01). The area under the receiver operating characteristic curves were 0.67 (95% CI = 0.60-0.75) and 0.60 (95% CI = 0.56-0.65) for the authors' logistic regression model and EuroSCORE II, respectively (p = 0.11). CONCLUSIONS The study authors identified six independent risk factors for three-year mortality after isolated AVR. The logistic regression model had relatively modest predictive performance for three-year mortality.
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Affiliation(s)
- Antoine Beurton
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France.
| | - Thomas Ferté
- CHU Bordeaux, Department of Public Health, Service of medical information, informatics and medical archives, Bordeaux, France
| | - Stefano Mion
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Thibaud Besnard
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Olivier Jecker
- CHU Bordeaux, Department of Technical Engineering, Bordeaux, France
| | - Alain Remy
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France
| | - Louis Labrousse
- CHU Bordeaux, Department of Cardiovascular Surgery, Haut-Lévêque Hospital, Bordeaux, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
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14
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Abstract
PURPOSE OF REVIEW In this review, we discuss recent developments and trends in the perioperative management of thrombocytopenia. RECENT FINDINGS Large contemporary data base studies show that preoperative thrombocytopenia is present in about 8% of asymptomatic patients, and is associated with increased risks for bleeding and 30-day mortality. Traditionally specific threshold platelet counts were recommended for specific procedures. However, the risk of bleeding may not correlate well with platelet counts and varies with platelet function depending on the underlying etiology. Evidence to support prophylactic platelet transfusion is limited and refractoriness to platelet transfusion is common. A number of options exist to optimize platelet counts prior to procedures, which include steroids, intravenous immunoglobulin, thrombopoietin receptor agonists, and monoclonal antibodies. In addition, intraoperative alternatives and adjuncts to transfusion should be considered. It appears reasonable to use prophylactic desmopressin and antifibrinolytic agents, whereas activated recombinant factor VII could be considered in severe bleeding. Other options include enhancing thrombin generation with prothrombin complex concentrate or increasing fibrinogen levels with fibrinogen concentrate or cryoprecipitate. SUMMARY Given the lack of good quality evidence, much research remains to be done. However, with a multidisciplinary multimodal perioperative strategy, the risk of bleeding can be decreased effectively.
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15
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A practical approach to evaluating postoperative thrombocytopenia. Blood Adv 2021; 4:776-783. [PMID: 32097460 DOI: 10.1182/bloodadvances.2019001414] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/21/2020] [Indexed: 12/19/2022] Open
Abstract
Identifying the cause(s) of postoperative thrombocytopenia is challenging. The postoperative period includes numerous interventions, including fluid administration and transfusion of blood products, medication use (including heparin), and increased risk of organ dysfunction and infection. Understanding normal thrombopoietin physiology and the associated expected postoperative platelet count changes is the crucial first step in evaluation. Timing of thrombocytopenia is the most important feature when differentiating causes of postoperative thrombocytopenia. Thrombocytopenia within 4 days of surgery is commonly caused by hemodilution and increased perioperative platelet consumption prior to thrombopoietin-induced platelet count recovery and transient platelet count overshoot. A much broader list of possible conditions that can cause late-onset thrombocytopenia (postoperative day 5 [POD5] or later) is generally divided into consumptive and destructive causes. The former includes common (eg, infection-associated disseminated intravascular coagulation) and rare (eg, postoperative thrombotic thrombocytopenic purpura) conditions, whereas the latter includes such entities as drug-induced immune thrombocytopenia or posttransfusion purpura. Heparin-induced thrombocytopenia is a unique entity associated with thrombosis that is typically related to intraoperative/perioperative heparin exposure, although it can develop following knee replacement surgery even in the absence of heparin exposure. Very late onset (POD10 or later) of thrombocytopenia can indicate bacterial or fungal infection. Lastly, thrombocytopenia after mechanical device implantation requires unique considerations. Understanding the timing and severity of postoperative thrombocytopenia provides a practical approach to a common and challenging consultation.
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17
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Matzek LJ, Hanson AC, Schulte PJ, Evans KD, Kor DJ, Warner MA. The Prevalence and Clinical Significance of Preoperative Thrombocytopenia in Adults Undergoing Elective Surgery: An Observational Cohort Study. Anesth Analg 2021; 132:836-845. [PMID: 33433115 DOI: 10.1213/ane.0000000000005347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preoperative thrombocytopenia is associated with inferior outcomes in surgical patients, though concurrent anemia may obfuscate these relationships. This investigation assesses the prevalence and clinical significance of preoperative thrombocytopenia with thorough consideration of preoperative anemia status. METHODS This is an observational cohort study of adults undergoing elective surgery with planned postoperative hospitalization from January 1, 2009 to May 3, 2018. Patients were designated into 4 groups: normal platelet and hemoglobin concentrations, isolated thrombocytopenia (ie, platelet count <100 × 109/L), isolated anemia (ie, hemoglobin <12 g/dL women, <13.5 g/dL men), and thrombocytopenia with anemia. Thrombocytopenia was further defined as incidental (ie, previously undiagnosed) or nonincidental. Multivariable regression analyses were utilized to assess the relationships between thrombocytopenia status and clinical outcomes, with a primary outcome of hospital length of stay. RESULTS A total of 120,348 patients were included for analysis: 72.3% (95% confidence interval [CI], 72.1-72.6) normal preoperative laboratory values, 26.3% (26.1-26.6) isolated anemia, 0.80% (0.75-0.86) thrombocytopenia with anemia, and 0.52% (0.48-0.56) isolated thrombocytopenia (0.38% [0.34-0.41] nonincidental, 0.14% [0.12-0.17] incidental). Thrombocytopenia was associated with longer hospital length of stay in those with concurrent anemia (multiplicative increase of the geometric mean 1.05 [1.00, 1.09] days; P = .034) but not in those with normal preoperative hemoglobin concentrations (multiplicative increase of the geometric mean 1.02 [0.96, 1.07] days; P = .559). Thrombocytopenia was associated with increased odds for intraoperative transfusion regardless of anemia status (nonanemic: 3.39 [2.79, 4.12]; P < .001 vs anemic: 2.60 [2.24, 3.01]; P < .001). Thrombocytopenia was associated with increased rates of intensive care unit (ICU) admission in nonanemic patients (1.56 [1.18, 2.05]; P = .002) but not in those with preoperative anemia (0.93 [0.73, 1.19]; P = .578). CONCLUSIONS Preoperative thrombocytopenia is associated with clinical outcomes in elective surgery, both in the presence and absence of concurrent anemia. However, isolated thrombocytopenia is rare (0.5%) and is usually identified before preoperative testing. It is unlikely that routine thrombocytopenia screening is indicated for most patients.
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Affiliation(s)
- Luke J Matzek
- From the Department of Anesthesiology and Perioperative Medicine
| | | | | | | | - Daryl J Kor
- From the Department of Anesthesiology and Perioperative Medicine.,Department of Biomedical Statistics and Informatics
| | - Matthew A Warner
- From the Department of Anesthesiology and Perioperative Medicine.,Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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18
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Sheyn D, Darvish R, Nayak L, Myer S, Claridge C, Bretschneider CE. Perioperative outcomes for benign hysterectomy among women with thrombocytopenia. Int J Gynaecol Obstet 2021; 154:233-240. [PMID: 33420719 DOI: 10.1002/ijgo.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/28/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether mild or moderate thrombocytopenia is associated with postoperative complications after benign hysterectomy. METHODS A retrospective study of data from women who underwent benign hysterectomy included in the American College of Surgeons National Surgical Quality Improvement Project Database. The data were stratified by normal platelet count, mild thrombocytopenia (100-149 × 103 platelets/µl), and moderate thrombocytopenia (50-99 × 103 platelets/µl). Multivariable logistic regression was used to determine the relationship between mild or moderate thrombocytopenia and the main outcome measures. RESULTS Moderate thrombocytopenia was associated with an increased risk of perioperative transfusion (adjusted odds ratio [aOR], 2.87; 95% confidence interval [CI], 1.96-4.21) and reoperation (aOR, 4.03; 95% CI, 1.94-17.33), but mild thrombocytopenia was not. There was an increased risk of infection among women with both mild (aOR, 1.38; 95% CI, 1.12-1.69) and moderate (aOR, 2.00; 95% CI,1.23-3.22) thrombocytopenia. There was no association between either mild or moderate thrombocytopenia and readmission, prolonged hospital stay, or longer surgical time. CONCLUSION Thrombocytopenia was found to be associated with increased infectious morbidity after hysterectomy, and moderate thrombocytopenia was associated with an increased risk of perioperative transfusion and reoperation.
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Affiliation(s)
- David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA.,Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA.,Section of Urogynecology and Reconstructive Pelvic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ryan Darvish
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA.,Section of Urogynecology and Reconstructive Pelvic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lalitha Nayak
- Section of Urogynecology and Reconstructive Pelvic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Hematology & Oncology, Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sara Myer
- Section of Urogynecology and Reconstructive Pelvic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Caitlin Claridge
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, OH, USA.,Section of Urogynecology and Reconstructive Pelvic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
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Storch EK, Custer BS, Jacobs MR, Menitove JE, Mintz PD. Review of current transfusion therapy and blood banking practices. Blood Rev 2019; 38:100593. [PMID: 31405535 DOI: 10.1016/j.blre.2019.100593] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 01/28/2023]
Abstract
Transfusion Medicine is a dynamically evolving field. Recent high-quality research has reshaped the paradigms guiding blood transfusion. As increasing evidence supports the benefit of limiting transfusion, guidelines have been developed and disseminated into clinical practice governing optimal transfusion of red cells, platelets, plasma and cryoprecipitate. Concepts ranging from transfusion thresholds to prophylactic use to maximal storage time are addressed in guidelines. Patient blood management programs have developed to implement principles of patient safety through limiting transfusion in clinical practice. Data from National Hemovigilance Surveys showing dramatic declines in blood utilization over the past decade demonstrate the practical uptake of current principles guiding patient safety. In parallel with decreasing use of traditional blood products, the development of new technologies for blood transfusion such as freeze drying and cold storage has accelerated. Approaches to policy decision making to augment blood safety have also changed. Drivers of these changes include a deeper understanding of emerging threats and adverse events based on hemovigilance, and an increasing healthcare system expectation to align blood safety decision making with approaches used in other healthcare disciplines.
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Affiliation(s)
| | - Brian S Custer
- UCSF Department of Laboratory Medicine, Blood Systems Research Institute, USA.
| | - Michael R Jacobs
- Department of Pathology, Case Western Reserve University, USA; Department of Clinical Microbiology, University Hospitals Cleveland Medical Center, USA.
| | - Jay E Menitove
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, USA
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