title: Preoperative platelet transfusions and perioperative red blood cell requirements in patients with thrombocytopenia undergoing noncardiac surgery.
abstract: BACKGROUND
  Perioperative hemorrhage impacts patient outcomes and health care resource utilization, yet the risks of transfusion therapies are significant. In patients with preoperative thrombocytopenia, the effects of prophylactic preoperative platelet (PLT) transfusion on perioperative bleeding complications remain uncertain.
  
  
  METHODS
  This is a retrospective cohort study of noncardiac surgical patients between January 1, 2008, and December 31, 2011. Propensity-adjusted analyses were used to evaluate associations between preoperative thrombocytopenia, preoperative PLT transfusion, and the outcomes of interest, with a primary outcome of perioperative red blood cell (RBC) transfusion.
  
  
  RESULTS
  A total of 13,978 study participants were included; 860 (6.2%) had a PLT count of not more than 100 × 10(9) /L with 71 (8.3%) receiving PLTs preoperatively. Administration of PLTs was associated with higher rates of perioperative RBC transfusion (66.2% vs. 49.1%, p = 0.0065); however, in propensity-adjusted analysis there was no significant difference between groups (odds ratio [OR] [95% confidence interval {95% CI}], 1.68 [0.95-2.99]; p = 0.0764]. Patients receiving PLTs had higher rates of intensive care unit (ICU) admission (OR [95% CI], 1.95 [1.10-3.46]; p = 0.0224) and longer hospital lengths of stay (estimate [95% bootstrap CI], 7.2 [0.8-13.9] days; p = 0.0006) in propensity-adjusted analyses.
  
  
  CONCLUSIONS
  Preoperative PLT transfusion did not attenuate RBC requirements in patients with thrombocytopenia undergoing noncardiac surgery. Moreover, preoperative PLT transfusion was associated with increased ICU admission rates and hospital duration. These findings suggest that more conservative management of preoperative thrombocytopenia may be warranted.
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.|Perioperative Outcomes, Information and Transfusion Study Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Warner
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.|Perioperative Outcomes, Information and Transfusion Study Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Qing
authors.initials: Q
authors.lastname: Jia
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.|Perioperative Outcomes, Information and Transfusion Study Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Leanne
authors.initials: L
authors.lastname: Clifford
authors.affiliation: Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, Minnesota.|Perioperative Outcomes, Information and Transfusion Study Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilson
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.|Perioperative Outcomes, Information and Transfusion Study Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Brown
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hanson
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.|Perioperative Outcomes, Information and Transfusion Study Group, Mayo Clinic, Rochester, Minnesota.
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Kor
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004912:Erythrocytes; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D059035:Perioperative Period; D017713:Platelet Transfusion / Q000706:statistics & numerical data*; D057234:Preoperative Period; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000601:surgery* / Q000628:therapy*