Aynaszyan Stephan, Udoeyo Idorenyin F, DelSole Edward M
Geisinger Commonwealth School of Medicine, 525 Pine St., Scranton, PA, 18510, USA.
Department of Spine Surgery, Geisinger Musculoskeletal Institute, 3 W. Olive St., Scranton, PA, 18508, USA.
N Am Spine Soc J. 2022 Apr 1;10:100116. doi: 10.1016/j.xnsj.2022.100116. eCollection 2022 Jun.
Low preoperative platelet count, or thrombocytopenia, has previously been associated with increased complications in elective spine surgeries. No other study has investigated the effects of abnormal coagulation profiles on postoperative outcomes specific to lumbar microdiscectomy (MLD) using a propensity matched cohort.
Patient data was retrospectively retrieved from the National Surgical Quality Improvement Program database using Current Procedural Terminology (CPT) code 63030 to isolate patients who solely underwent MLD. Data was collected from 2010 to 2019 and included preoperative, perioperative, and 30-day postoperative variables. Patients were grouped into four platelet categories for ANOVA analysis and pairwise comparisons: Severe Thrombocytopenia (≤100), Thrombocytopenia (101-150), Moderate (151-199), and Normal (200-450). Variables that were significant in the univariate analysis were used in the multivariate analysis to determine the likelihood of experiencing adverse postoperative events - unplanned return to the operating room and surgical site infection. A propensity matched analysis was performed to control for confounding variables.
A total of 64,747 patients were identified within the 10-year period. The results of the multivariate analysis and the propensity matched analysis showed no significant differences in low preoperative platelet count as an independent predictor of experiencing a return to the operating room or surgical site infection. Furthermore, patients who had diabetes, history of smoking, or had emergency cases were associated with a high likelihood of experiencing these negative adverse events.
Thrombocytopenia does not appear to independently predict return to the operating room or postoperative infection following MLD. Proper preoperative management strategies should be implemented to monitor comorbidity burden which would otherwise influence adverse outcomes in patients with thrombocytopenia undergoing MLD.
术前血小板计数低，即血小板减少症，此前已被认为与择期脊柱手术并发症增加有关。尚无其他研究使用倾向匹配队列来调查异常凝血指标对腰椎间盘显微切除术（MLD）术后结局的影响。
使用当前手术操作术语（CPT）代码63030从国家外科质量改进计划数据库中回顾性检索患者数据，以分离仅接受MLD的患者。收集2010年至2019年的数据，包括术前、围手术期和术后30天的变量。患者被分为四个血小板类别进行方差分析和两两比较：严重血小板减少症（≤100）、血小板减少症（101 - 150）、中度（151 - 199）和正常（200 - 450）。单变量分析中有显著意义的变量用于多变量分析，以确定发生术后不良事件——计划外返回手术室和手术部位感染的可能性。进行倾向匹配分析以控制混杂变量。
在这10年期间共识别出64,747名患者。多变量分析和倾向匹配分析的结果显示，术前血小板计数低作为返回手术室或手术部位感染的独立预测因素没有显著差异。此外，患有糖尿病、有吸烟史或急诊病例的患者发生这些负面不良事件的可能性较高。
血小板减少症似乎不能独立预测MLD术后返回手术室或术后感染。应实施适当的术前管理策略来监测合并症负担，否则这些合并症会影响接受MLD的血小板减少症患者的不良结局。
