Lee Cameron C, Wang Tim T, Liang Lang, Jenkins Glyndwr, Dyalram Donita, Lubek Joshua E
Assistant Professor, Oral and Maxillofacial Surgery, University of Maryland Medical Center, Baltimore, MD.
Resident, Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA.
J Oral Maxillofac Surg. 2025 Jun 26. doi: 10.1016/j.joms.2025.06.225.
Thrombocytopenia is associated with a variety of medical comorbidities seen in patients with head and neck cancer. However, it remains unclear if and how thrombocytopenia affects surgical outcomes.
The purpose of this study was to measure the association between thrombocytopenia and 30-day adverse outcomes in patients undergoing head and neck cancer surgery with free flap reconstruction.
STUDY DESIGN, SETTING SAMPLE: This was a retrospective cohort study using the 2012 to 2022 American College of Surgeons National Surgical Quality Improvement Program databases. Patients undergoing resection and free flap reconstruction for malignant pathology of the oral cavity, oropharynx, hypopharynx, larynx, and salivary glands were included. Patients undergoing emergency surgery or with missing outcomes data were excluded.
PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The predictor variable was platelet count coded as a binary variable: <150k/μL (thrombocytopenia) or >150k/μL.
The primary outcome variable was return to the operating room for free flap salvage or hematoma evacuation coded based on International Classification of Diseases diagnoses.
Covariates were categorized into demographic (age, sex), medical (hypertension, diabetes), and perioperative (concurrent procedures, reconstructive modality).
Descriptive, bivariate, and bootstrapped multiple logistic regression statistics were performed to evaluate the association between thrombocytopenia and adverse outcomes. Youden J analysis was used to identify a platelet value at which complications were more likely to occur. An alpha of P < .05 was significant.
A total of 4,993 subjects met the inclusion criteria. There were 281 subjects with thrombocytopenia (5.63%) and 213 who underwent reoperations (4.30%). In bivariate analysis, thrombocytopenia was the only significant risk factor for reoperation, and these subjects were 1.74 times more likely to return to the operating room (P = .015, relative risk = 1.74, 95% CI 1.11 to 2.71). In multivariate analysis adjusting for study covariates, thrombocytopenia was independently associated with 1.82 times greater odds of return to the operating room (P = .026, OR = 1.82, 95% CI 1.11 to 3.26). Cut point analysis suggested that a platelet value less than 136,000/μL was a risk factor for return to the operating room.
Thrombocytopenia was independently associated with return to the operating room following ablative head and neck cancer procedures with free flap reconstruction.
血小板减少症与头颈癌患者中出现的多种医学合并症相关。然而，血小板减少症是否以及如何影响手术结果仍不清楚。
本研究的目的是测量血小板减少症与接受头颈癌手术并行游离皮瓣重建的患者30天不良结局之间的关联。
研究设计、设置、样本：这是一项回顾性队列研究，使用2012年至2022年美国外科医师学会国家外科质量改进计划数据库。纳入接受口腔、口咽、下咽、喉和唾液腺恶性病变切除及游离皮瓣重建的患者。排除接受急诊手术或结局数据缺失的患者。
预测因素/暴露因素/独立变量：预测变量是血小板计数，编码为二元变量：<150k/μL（血小板减少症）或>150k/μL。
主要结局变量是根据国际疾病分类诊断编码的因游离皮瓣挽救或血肿清除而返回手术室的情况。
协变量分为人口统计学（年龄、性别）、医学（高血压、糖尿病）和围手术期（同期手术、重建方式）。
进行描述性、双变量和自抽样多重逻辑回归统计，以评估血小板减少症与不良结局之间的关联。使用约登J分析来确定更可能发生并发症的血小板值。P <.05具有统计学意义。
共有4993名受试者符合纳入标准。有281名血小板减少症受试者（5.63%）和213名接受再次手术的受试者（4.30%）。在双变量分析中，血小板减少症是再次手术的唯一显著危险因素，这些受试者返回手术室的可能性高1.74倍（P =.015，相对风险 = 1.74，95%可信区间1.11至2.71）。在对研究协变量进行调整的多变量分析中，血小板减少症与返回手术室的几率高1.82倍独立相关（P =.026，比值比 = 1.82，95%可信区间1.11至3.26）。切点分析表明，血小板值低于136,000/μL是返回手术室的危险因素。
血小板减少症与行游离皮瓣重建的头颈癌根治术后返回手术室独立相关。
