title: Analysis of outcome of laparoscopic splenectomy for idiopathic thrombocytopenic purpura by platelet count.
abstract: Laparoscopic splenectomy (LS) is now performed routinely in patients with idiopathic thrombocytopenic purpura (ITP) refractory to the medical treatment. Low preoperative platelet count was deemed to be a contraindication for a laparoscopic approach; however, there is no data reporting the outcome in those patients. We aimed to evaluate the influence of the preoperative platelet count on the operative and postoperative course and complication rate. Retrospective cohort study that was conducted in tertiary care university-affiliated medical center and included 110 consecutive patients who underwent LS. All patients were divided into three groups by their preoperative platelet counts: <or=20 x 10(9)/L (n = 12), (20-50) x 10(9)/L (n = 18), and >50 x 10(9)/L (n = 80). The outcome and the influence of preoperative factors predictive of complications, blood transfusion, and length of stay were compared between the groups. Patients with a platelet count of <or=20 x 10(9)/L had a much longer hospital stay, received more blood transfusions, and suffered more complications than patients with platelet counts of (20-50) x 10(9)/L or higher (P < 0.05). Transfused patients had a longer hospital stay than non-transfused patients (2.08 vs. 6.4 days, P = 0.029). The strongest predictor for transfusion was the platelet count (odds ratio = 23, P = 0.008). LS in patients with very low platelet counts is feasible and reasonably safe, but the platelet count is a major determinant of morbidity. Every effort should be made to elevate platelet levels to >20 x 10(9)/L before surgery. Patients with counts >20 x 10(9)/L can safely undergo LS.
authors.affiliation: Department of Surgery B, Tel Aviv Sourasky Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. akeidar@surgery.usc.edu
authors.forename: A
authors.initials: A
authors.lastname: Keidar
authors.forename: M
authors.initials: M
authors.lastname: Feldman
authors.forename: A
authors.initials: A
authors.lastname: Szold
mesh_terms: D001803:Blood Transfusion; D015331:Cohort Studies; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D010976:Platelet Count; D011183:Postoperative Complications; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome