From the Department of Anesthesiology and Perioperative Medicine.
Department of Biomedical Statistics and Informatics.
Anesth Analg. 2021 Mar 1;132(3):836-845. doi: 10.1213/ANE.0000000000005347.
Preoperative thrombocytopenia is associated with inferior outcomes in surgical patients, though concurrent anemia may obfuscate these relationships. This investigation assesses the prevalence and clinical significance of preoperative thrombocytopenia with thorough consideration of preoperative anemia status.
This is an observational cohort study of adults undergoing elective surgery with planned postoperative hospitalization from January 1, 2009 to May 3, 2018. Patients were designated into 4 groups: normal platelet and hemoglobin concentrations, isolated thrombocytopenia (ie, platelet count <100 × 109/L), isolated anemia (ie, hemoglobin <12 g/dL women, <13.5 g/dL men), and thrombocytopenia with anemia. Thrombocytopenia was further defined as incidental (ie, previously undiagnosed) or nonincidental. Multivariable regression analyses were utilized to assess the relationships between thrombocytopenia status and clinical outcomes, with a primary outcome of hospital length of stay.
A total of 120,348 patients were included for analysis: 72.3% (95% confidence interval [CI], 72.1-72.6) normal preoperative laboratory values, 26.3% (26.1-26.6) isolated anemia, 0.80% (0.75-0.86) thrombocytopenia with anemia, and 0.52% (0.48-0.56) isolated thrombocytopenia (0.38% [0.34-0.41] nonincidental, 0.14% [0.12-0.17] incidental). Thrombocytopenia was associated with longer hospital length of stay in those with concurrent anemia (multiplicative increase of the geometric mean 1.05 [1.00, 1.09] days; P = .034) but not in those with normal preoperative hemoglobin concentrations (multiplicative increase of the geometric mean 1.02 [0.96, 1.07] days; P = .559). Thrombocytopenia was associated with increased odds for intraoperative transfusion regardless of anemia status (nonanemic: 3.39 [2.79, 4.12]; P < .001 vs anemic: 2.60 [2.24, 3.01]; P < .001). Thrombocytopenia was associated with increased rates of intensive care unit (ICU) admission in nonanemic patients (1.56 [1.18, 2.05]; P = .002) but not in those with preoperative anemia (0.93 [0.73, 1.19]; P = .578).
Preoperative thrombocytopenia is associated with clinical outcomes in elective surgery, both in the presence and absence of concurrent anemia. However, isolated thrombocytopenia is rare (0.5%) and is usually identified before preoperative testing. It is unlikely that routine thrombocytopenia screening is indicated for most patients.
术前血小板减少与手术患者的预后不良有关，尽管同时存在贫血可能会使这些关系变得复杂。本研究评估了在充分考虑术前贫血状态的情况下，术前血小板减少的患病率和临床意义。
这是一项观察性队列研究，纳入了 2009 年 1 月 1 日至 2018 年 5 月 3 日期间择期手术并计划术后住院的成年人。患者分为 4 组：血小板和血红蛋白浓度正常、单纯血小板减少（即血小板计数＜100×109/L）、单纯贫血（即女性血红蛋白＜12g/dL，男性血红蛋白＜13.5g/dL）和血小板减少伴贫血。血小板减少进一步分为偶发性（即以前未诊断）或非偶发性。采用多变量回归分析评估血小板减少状态与临床结局之间的关系，主要结局为住院时间。
共纳入 120348 例患者进行分析：72.3%（95%置信区间[CI]，72.1-72.6）患者术前实验室值正常，26.3%（26.1-26.6）患者单纯贫血，0.80%（0.75-0.86）患者血小板减少伴贫血，0.52%（0.48-0.56）患者单纯血小板减少（0.38%[0.34-0.41]为偶发性，0.14%[0.12-0.17]为非偶发性）。在伴有贫血的患者中，血小板减少与住院时间延长相关（几何均数的倍增[1.05]为 1.00，1.09]天；P =.034），但在血红蛋白浓度正常的患者中则不然（几何均数的倍增[1.02]为 1.00，1.07]天；P =.559）。无论是否存在贫血，血小板减少均与术中输血的几率增加相关（非贫血患者：3.39[2.79，4.12]；P <.001 vs 贫血患者：2.60[2.24，3.01]；P <.001）。血小板减少与非贫血患者入住重症监护病房（ICU）的几率增加相关（1.56[1.18，2.05]；P =.002），但与术前贫血患者无关（0.93[0.73，1.19]；P =.578）。
在择期手术中，术前血小板减少与临床结局相关，无论是否存在同时存在贫血。然而，单纯性血小板减少症（0.5%）很少见，通常在术前检查前就已经发现。对于大多数患者来说，不太可能需要常规进行血小板减少症筛查。
