title: Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura.
abstract: OBJECTIVE
  Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS).
  
  
  METHODS
  Case series.
  
  
  METHODS
  Private, tertiary care referral center.
  
  
  METHODS
  Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001.
  
  
  METHODS
  Laparoscopic splenectomy.
  
  
  METHODS
  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.
authors.affiliation: Minimally Invasive Surgery Center and Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Terive
authors.initials: T
authors.lastname: Duperier
authors.forename: Fred
authors.initials: F
authors.lastname: Brody
authors.forename: Joshua
authors.initials: J
authors.lastname: Felsher
authors.forename: R Matthew
authors.initials: RM
authors.lastname: Walsh
authors.forename: Michael
authors.initials: M
authors.lastname: Rosen
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Ponsky
mesh_terms: D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000276:immunology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013156:Splenectomy / Q000009:adverse effects / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome