title: Preoperative thrombocytopenia and postoperative outcomes after noncardiac surgery.
abstract: BACKGROUND
  Most studies examining the prognostic value of preoperative coagulation testing are too small to examine the predictive value of routine preoperative coagulation testing in patients having noncardiac surgery.
  
  
  METHODS
  Using data from the American College of Surgeons National Surgical Quality Improvement database, the authors performed a retrospective observational study on 316,644 patients having noncardiac surgery who did not have clinical indications for preoperative coagulation testing. The authors used multivariable logistic regression analysis to explore the association between platelet count abnormalities and red cell transfusion, mortality, and major complications.
  
  
  RESULTS
  Thrombocytopenia or thrombocytosis occurred in 1 in 14 patients without clinical indications for preoperative platelet testing. Patients with mild thrombocytopenia (101,000-150,000 µl), moderate-to-severe thrombocytopenia (<100,000 µl), and thrombocytosis (≥450,000 µl) were significantly more likely to be transfused (7.3%, 11.8%, 8.9%, 3.1%) and had significantly higher 30-day mortality rates (1.5%, 2.6%, 0.9%, 0.5%) compared with patients with a normal platelet count. In the multivariable analyses, mild thrombocytopenia (adjusted odds ratio [AOR], 1.28; 95% CI, 1.18-1.39) and moderate-to-severe thrombocytopenia (AOR, 1.76; 95% CI, 1.49-2.08), and thrombocytosis (AOR, 1.44; 95% CI, 1.30-1.60) were associated with increased risk of blood transfusion. Mild thrombocytopenia (AOR, 1.31; 95% CI, 1.11-1.56) and moderate-to-severe thrombocytopenia (AOR, 1.93; 95% CI, 1.43-2.61) were also associated with increased risk of 30-day mortality, whereas thrombocytosis was not (AOR, 0.94; 95% CI, 0.72-1.22).
  
  
  CONCLUSIONS
  Platelet count abnormalities found in the course of routine preoperative screening are associated with a higher risk of blood transfusion and death.
authors.affiliation: From the Department of Anesthesiology (L.G.G., M.P.E., S.J.L., R.W., R.Z., M.K.), Department of Pathology and Laboratory Medicine (N.B.), Department of Biostatistics and Computational Biology (C.F.), University of Rochester School of Medicine, Rochester, New York; the Department of Surgery (T.M.O.), University of Vermont College of Medicine, Burlington, Vermont; and RAND Health (A.W.D.), RAND, Boston, Massachusetts.
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Neil
authors.initials: N
authors.lastname: Blumberg
authors.forename: Michael P
authors.initials: MP
authors.lastname: Eaton
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Lustik
authors.forename: Turner M
authors.initials: TM
authors.lastname: Osler
authors.forename: Richard
authors.initials: R
authors.lastname: Wissler
authors.forename: Ray
authors.initials: R
authors.lastname: Zollo
authors.forename: Marcin
authors.initials: M
authors.lastname: Karcz
authors.forename: Changyong
authors.initials: C
authors.lastname: Feng
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology / Q000401:mortality; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D010979:Platelet Function Tests; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods* / Q000401:mortality; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications* / Q000401:mortality; D013922:Thrombocytosis / Q000097:blood; D016896:Treatment Outcome