Adverse postoperative outcomes in surgical patients with immune thrombocytopenia.

BACKGROUND Patients with immune thrombocytopenia (ITP) are likely to have various medical co-morbidities, yet their global features regarding adverse postoperative outcomes and use of medical resources when undergoing major surgery are unknown. The objective of this study was to validate whether ITP is an independent risk factor for adverse postoperative outcomes, and to explore the potential clinical predictors of outcomes after major surgery among patients with ITP. METHODS A retrospective population-based cohort study was conducted using Taiwan's National Health Insurance Research Database, controlling for preoperative co-morbidities by means of multiple logistic regression. Major postoperative complication and mortality rates, and in-hospital medical costs were analysed. RESULTS The study included 11,085 surgical patients with ITP and 44,340 controls without ITP matched for sex, age, and type of surgery and anaesthesia. Surgical patients with ITP had a higher risk of postoperative death (odds ratio (OR) 1.89, 95 per cent confidence interval 1.57 to 2.27), and overall postoperative complications (OR 1.47, 1.39 to 1.56), and increased hospital stay (OR 1.90, 1.80 to 2.01), admission to the intensive care unit (OR 1.73, 1.63 to 1.83) and medical costs (OR 1.89, 1.79 to 1.99). Amount of preoperative platelet and/or red blood cell transfusion, emergency visits and admission to hospital for ITP care were identified as risk factors for adverse postoperative outcomes. CONCLUSION Patients with ITP undergoing surgery are at increased risk of adverse perioperative events, particularly if blood or blood product transfusion are required preoperatively, or the procedure is done as an emergency.