Thrombocytosis is associated with complications after microvascular surgery: An NSQIP data analysis

Abstract

Background Complications after microvascular surgery, such as partial flap loss, and arterial/venous compromise cannot only increase morbidity for the patient but also tax the healthcare system. Thrombocytosis, both essential and reactive, can predispose patients to thrombosis and hemorrhage and thus should intuitively have an effect on the outcome of microvascular free tissue transfers. We sought to evaluate the effect of preoperative thrombocytosis on outcomes after microvascular free flap surgery. Methods A retrospective review of the 2013–2016 American Collges of Surgeons, National Surgical Quality Improvement Program (ACS NSQIP) database identified 4,299 patients who had microsurgical flaps. Of these 3,744 had preoperative platelet levels recorded. Fifty‐four patients had preoperative thrombocytosis, defined as a platelet count >450 K/CUMM, while 3,690 did not. The groups were compared; demographics, comorbidities, and smoking status were recorded. We then examined outcomes between groups including average operative time, length of hospital stay, need for transfusion, deep vein thrombosis (DVT) postoperatively, and need for reoperation. Results When comparing the two cohorts, there was no statistical difference in comorbidities. We found a significant difference between the thrombocytosis and control cohort in need for transfusion (29.6 vs. 12.8%, p = .0002), average days till discharge (8.36 vs. 5.75, p = .009), and need for reoperation (27.8 vs. 13.8%, p = .003). There was no difference in DVT occurrence (0 vs. 0.1%, p = .46) or average operation time (535 m vs. 482 min, p = .088). Conclusion Patients with thrombocytosis undergoing microvascular free flaps are at increased risk for complications, including the need for a blood transfusion, prolonged hospital stays, and reoperation.

Preoperative Predictors of Free Flap Failure

“…In a large study not specific to the head and neck, premorbid thrombocytosis in patients undergoing free tissue transfer not only prolonged their hospital stay but was associated with increased rates of postoperative complications and immediate revision surgery unrelated to flap vitality. 16 Platelet aggregation is necessary to activate the coagulation cascade, the end product of which is thrombosis, a known and important contributor to early free flap failure. 4,8,9 The role of thrombolytics to promote overall flap health and survival is controversial.…”

Thrombocytosis Predicts Surgical Site Infection in Head and Neck Microvascular Surgery‐ A Pilot Study

“…Due to this, POTCT has been used as a reliable marker of complications in urologic and colorectal surgery 7–9 . Similarly, preoperative thrombocytosis has also been used as a marker to predict postoperative complications, possibly due to underlying inflammatory responses that can inhibit wound‐healing 11–13 …”

Head and Neck Reconstruction in Patients with Polycythemia Vera: Case Series and Literature Review

“…11 Similarly, Tarabishy et al reported an increased risk for blood transfusion in patients with preoperative thrombocytosis (> 450,000/μL). 12 Therefore, based on available evidence and a lack of literature on the current population, we recommend PLT levels to be maintained above the lower limit of normal and below 361,000/μL with a goal of approximately 200,000/ μL to optimize postoperative outcomes.…”