title: Co-existing liver disease increases the risk of postoperative thrombocytopenia in patients undergoing hepatic resection: implications for the risk of epidural hematoma associated with the removal of an epidural catheter.
abstract: OBJECTIVE
  A common surgical diagnosis for hepatic resection in Japan is hepatocellular carcinoma secondary to chronic viral hepatitis. It is known that chronic liver disease causes a decrease in blood platelet count. We retrospectively reviewed the perioperative changes in blood platelet count associated with hepatic resection at a Japanese institution and evaluated the incidence and risk factors for postoperative thrombocytopenia, which may increase the potential risk of epidural hematoma.
  
  
  METHODS
  We analyzed the data of 165 patients who underwent hepatic resection between 1 March 2010 and 30 June 2012 at Hokkaido University Hospital. The criterion of the platelet count for the unsafe removal of epidural catheter was <100,000/μL. Logistic regression was used to model the association between postoperative thrombocytopenia and co-existing liver disease, estimated blood loss and type of hepatic resection.
  
  
  RESULTS
  After hepatic resection, 42.4 % of patients without preoperative thrombocytopenia experienced thrombocytopenia. The presence of co-existing liver disease was identified as a risk factor for postoperative thrombocytopenia [odds ratio 3.17 (95 % confidence interval 1.63-6.18)]. There was no epidural hematoma in the 149 patients who had epidural anesthesia.
  
  
  CONCLUSIONS
  Hepatic resection can cause postoperative thrombocytopenia that may increase the potential risk of epidural hematoma associated with catheter removal, and the presence of co-existing liver disease heightens concerns for postoperative crucial thrombocytopenia.
authors.affiliation: Department of Anesthesiology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan, ktakita@med.hokudai.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Takita
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Uchida
authors.forename: Tetsutaro
authors.initials: T
authors.lastname: Hase
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morimoto
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D057785:Catheters; D020878:Device Removal; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000453:epidemiology*; D006801:Humans; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D013921:Thrombocytopenia / Q000453:epidemiology* / Q000209:etiology