Preoperative platelet counts and postoperative outcomes in cancer surgery: a multicenter, retrospective cohort study

Abstract

Platelets play roles in malignancy, wound healing, and immunity. Nevertheless, their significance in postoperative outcomes is not established. This is a retrospective cohort study of 100,795 patients undergoing cancer surgery in 2010 and 2014 in >500 hospitals. Patients were stratified into five groups based on preoperative platelet counts. Multivariable logistic regression was used to determine the risk of 30-day mortality, morbidities, readmission, and prolonged hospitalization using the mid-normal group as a reference. We adjusted for demographic variables, comorbidities, and operation complexity. In the 2014 cohort, multivariable analysis showed that mortality was higher in patients with thrombocytopenia (OR 1.49, 95% CI [1.23–1.81]), high-normal platelets (OR 1.29, [1.06–1.55]), and thrombocytosis (OR 1.78, [1.45–2.19]). Composite postoperative morbidity followed a similar trend with thrombocytopenia (OR 1.34, [1.25–1.43]), high-normal counts (OR 1.41, [1.33–1.49]), and thrombocytosis (OR 2.20, [2.05–2.36]). Concordantly, the risks of prolonged hospitalization and 30-day readmission followed the same pattern. These results were validated in a large colon cancer cohort from the 2010 database. In conclusion, platelet count is a prognostic indicator in cancer surgeries. This could be related to the role of platelets in wound healing and immunity on one hand, and propagating malignancy on the other.

Keywords:

• Morbidity
• mortality
• oncology
• thrombocytes

Acknowledgements

We thank the American College of Surgeons for making the data available to perform this study. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Conflicts of Interest

The authors declare no conflicts of interest.

Supplementary Material

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