title: Thrombocytopenia and craniotomy for tumor: A National Surgical Quality Improvement Program analysis.
abstract: BACKGROUND
  To the authors' knowledge, the current study is the first national analysis of the association between preoperative platelet count and outcomes after craniotomy.
  
  
  METHODS
  Patients who underwent craniotomy for tumor were extracted from the prospective National Surgical Quality Improvement Program registry (2007-2014) and stratified by preoperative thrombocytopenia, defined as mild (125,000-149,000/μL), moderate (100,000-124,000/μL), severe (75,000-99,000/μL), or very severe (<75,000/μL). Cox proportional hazards analysis was used to evaluate the association between thrombocytopenia and 30-day mortality, and multivariable logistic regression with complications and unplanned reoperation. Covariates included patient age, sex, tumor histology, American Society of Anesthesiologists class, functional status, comorbidities, and surgical time.
  
  
  RESULTS
  A total of 14,852 patients were included in the current study and thrombocytopenia was classified as mild in 4.4% (646 patients), moderate in 2.0% (290 patients), severe in 0.7% (105 patients), or very severe in 0.4% (66 patients) of patients. The adjusted hazard of 30-day death was significantly higher for patients with moderate (6.6%; hazard ratio [HR], 2.13 [95% confidence interval (95% CI), 1.30-3.49; P =  0.003]), severe (10.5%; HR, 2.33 [95% CI, 1.18-4.60; P =  0.02]), and very severe (10.6%; HR, 3.65 [95% CI, 1.71-7.82; P =  0.001]) thrombocytopenia, compared with patients without thrombocytopenia (2.9%), with an increased effect size noted with greater thrombocytopenia. Likewise, when the platelet count was evaluated continuously, a higher platelet count was associated with a lower hazard of 30-day mortality (HR, 0.987 [95% CI, 0.981-0.993; P<.001]), developing any complication (odds ratio, 0.985 [95% CI, 0.981-0.988; P<.001]), and reoperation (odds ratio, 0.990 [95% CI, 0.983-0.994; P = .003]). Unplanned reoperation was due to intracranial hemorrhage in 53.3% of patients with moderate thrombocytopenia.
  
  
  CONCLUSIONS
  In this National Surgical Quality Improvement Program analysis, moderate and severe thrombocytopenia were associated with mortality and reoperation after craniotomy for tumor. Cancer 2016;122:1708-17. © 2016 American Cancer Society.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Hormuzdiyar H
authors.initials: HH
authors.lastname: Dasenbrock
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Devine
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Kevin X
authors.initials: KX
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: William B
authors.initials: WB
authors.lastname: Gormley
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Claus
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Dunn
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000097:blood / Q000401:mortality* / Q000601:surgery; D016001:Confidence Intervals; D003399:Craniotomy / Q000401:mortality* / Q000592:standards; D016208:Databases, Factual; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011183:Postoperative Complications / Q000601:surgery; D057234:Preoperative Period; D015397:Program Evaluation; D016016:Proportional Hazards Models; D058996:Quality Improvement; D012042:Registries / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D013921:Thrombocytopenia / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D016896:Treatment Outcome; D055815:Young Adult
keywords: National Surgical Quality Improvement Program (NSQIP); brain tumor; craniotomy; outcomes; platelet; thrombocytopenia