Peter Szasz, MD, PhD, Ali Ardestani, MD, Ali Tavakkoli, MD. Brigham and Women’s Hospital
Background: Venous thromboembolic (VTE) events are an ongoing problem for patients undergoing splenectomy. Although the rates vary in the literature based on whether the case is performed in an open or laparoscopic manner, most of the studies to date have evaluated unselected patients undergoing splenectomy for a variety of indications, often related to blunt or penetrating trauma. There is a paucity of data evaluating the relationship of VTE events in the elective splenectomy patient. Furthermore there is a paucity of literature evaluating platelet counts and their relationship to patients with VTEs in the elective splenectomy setting. The objective of this study was thus to determine the incidence of VTE events and to use the platelet count as a predictor of developing VTE events, in the elective splenectomy patient.
Methods: A retrospective chart review was undertaken in a major academic institution evaluating all patients who underwent an elective splenectomy completed between 1997 and 2014. Descriptive statistics were utilized to determine the incidence of thromboembolic events in patients undergoing both open and laparoscopic splenectomies. Receiver operator characteristic (ROC) curves were utilized to identify platelet counts that could predict VTEs.
Results: 420 patients underwent an elective splenectomy between 1997 and 2014. 266 were completed in an open manner and 154 were done laparoscopically. The incidence of VTE events overall was 6.2 % (26/420), 3.3 % (14/420) for open, and 2.9 % (12/420) for laparoscopic splenectomies. ROC curves demonstrated platelet counts to be a good predictor for the development of VTEs with an area under the curve (AUC) of 0 .79 ([95% confidence interval, 0.69 – 0.88]: P < 0.001) (Figure 1). The optimal platelet cutoff where sensitivy and specific were maximized was found to be 721. This platelet count had an 82% diagnostic accuracy and 97% negative predictive value for predicting the presence of VTE.
Conclusion: These results suggest a platelet cutoff that can predict the risk of VTEs. This information could be used to individualize prophylactic management strategies using aspirin for their prevention.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93502
Program Number: S152
Presentation Session: MIS Medley
Presentation Type: Podium
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