Are Patients with Thrombocytopenia at Higher Risk for Adverse Outcomes
after Hysterectomy for Benign Indications?
Abstract
Objective: To determine the risk of thrombocytopenia on postoperative
complication following hysterectomy for benign indications. Design:
Retrospective Cohort Setting: American College of Surgeons National
Surgical Quality Improvement database. Population: Women undergoing
hysterectomy by any route between 2014 and 2018 Methods: Patients
stratified into three groups: normal platelet count, mild
thrombocytopenia defined as a platelet count between 100 – 149 x 103
per microliter, and moderate thrombocytopenia defined as a platelet
count between 50 x 99 x 103 per microliter. Three group comparison was
performed using Kruskal-Wallis. If results were found to be
statistically significant, then pairwise analysis was performed between
reference group (normal platelet count) and experimental groups (mild
and moderate thrombocytopenia). Pairwise comparison was performed using
the Wilcoxon rank-sum test, Student’s t-test or Fisher’s exact test
where appropriate. Multivariable logistic regression was used to
determine the relationship between mild and moderate thrombocytopenia
and the main outcome measures. Main Outcome Measures: Postoperative
transfusion, infectious morbidity, readmission, reoperation, operating
time and duration of hospitalization. Results: Moderate thrombocytopenia
was associated with an increased risk of perioperative transfusion
(aOR=2.87, 95%CI: 1.96-4.21) and reoperation (aOR=4.03, 95%CI:
1.94-17.33) while mild thrombocytopenia was not. The risk of infection
increased with both mild and moderate thrombocytopenia, (aOR=1.38,
95%CI 1.12-1.69) and (aOR=2.00, 95%CI:1.23-3.22). Thrombocytopenia did
not increase the risk of readmission, prolonged hospitalization or
longer operating time. Conclusion: Thrombocytopenia is associated with
increased infectious morbidity after hysterectomy, and moderate
thrombocytopenia is associated with an increased risk of perioperative
transfusion and reoperation.