The Fu Foundation School of Engineering and Applied Science, Columbia University, New York, New York, United States of America.
Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, United States of America.
PLoS One. 2019 Feb 11;14(2):e0212191. doi: 10.1371/journal.pone.0212191. eCollection 2019.
Anemia and transfusion of blood in the peri-operative period have been shown to be associated with increased morbidity and mortality across a wide variety of non-cardiac surgeries. While tests of coagulation, including the platelet count, have frequently been used to identify patients with an increased risk of peri-operative bleeding, results have been equivocal. The aim of this study was to assess the effect of platelet level on outcomes in patients undergoing elective surgery.
Retrospective cohort analysis of prospectively-collected clinical data from American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between 2006-2016.
We identified 3,884,400 adult patients who underwent elective, non-cardiac surgery from 2006-2016 at hospitals participating in NSQIP, a prospectively-collected, national clinical database with established reproducibility and validity. After controlling for all peri- and intraoperative factors by matching on propensity scores, patients with all levels of thrombocytopenia or thrombocytosis had higher odds for perioperative transfusion. All levels of thrombocytopenia were associated with higher mortality, but there was no association with complications or other morbidity after matching. On the other hand, thrombocytosis was not associated with mortality; but odds for postoperative complications and 30-day return to the operating room remained slightly increased after matching.
These findings may guide surgeons in the appropriate use and appreciation of the utility of pre-operative screening of the platelet count prior to an elective, non-cardiac surgery.
围手术期贫血和输血已被证明与多种非心脏手术的发病率和死亡率增加有关。虽然凝血测试，包括血小板计数，经常被用于识别围手术期出血风险增加的患者，但结果并不明确。本研究旨在评估血小板水平对择期手术患者结局的影响。
回顾性队列分析来自美国外科医师学会国家外科质量改进计划（NSQIP）在 2006-2016 年期间前瞻性收集的临床数据。
我们确定了 2006-2016 年期间在参与 NSQIP 的医院接受择期非心脏手术的 3884400 名成年患者，这是一个前瞻性收集的全国临床数据库，具有可重复性和有效性。通过倾向评分匹配控制所有围手术期和术中因素后，血小板减少或血小板增多的所有水平的患者都有更高的围手术期输血几率。所有程度的血小板减少症都与更高的死亡率相关，但在匹配后与并发症或其他发病率没有关联。另一方面，血小板增多症与死亡率无关；但在匹配后，术后并发症和 30 天返回手术室的几率仍然略有增加。
这些发现可能指导外科医生在择期非心脏手术前适当使用和评估术前血小板计数筛查的效用。
