Co-existing liver disease increases the risk of postoperative thrombocytopenia in patients undergoing hepatic resection: implications for the risk of epidural hematoma associated with the removal of an epidural catheter

• Published in: Journal of anesthesia Vol. 28; no. 4; pp. 554 - 558
• Main Authors: Takita, Koichi, Uchida, Yosuke, Hase, Tetsutaro, Kamiyama, Toshiya, Morimoto, Yuji
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.08.2014; Springer
• Subjects: Aged; Anesthesia, Epidural - adverse effects; Anesthesiology; Care and treatment; Catheters; Complications and side effects; Critical Care Medicine; Device Removal; Emergency Medicine; Epidural hematoma; Female; Hematoma, Epidural, Spinal - epidemiology; Hepatectomy; Hepatoma; Humans; Intensive; Liver - surgery; Liver Diseases - complications; Liver Diseases - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Pain Medicine; Patient outcomes; Platelet Count; Postoperative Complications - epidemiology; Retrospective Studies; Risk; Risk factors; Thrombocytopenia; Thrombocytopenia - epidemiology; Thrombocytopenia - etiology; Japan; Thrombocytopenia; Co-existing liver disease; Epidural hematoma; Hepatic resection
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-013-1776-4

Purpose A common surgical diagnosis for hepatic resection in Japan is hepatocellular carcinoma secondary to chronic viral hepatitis. It is known that chronic liver disease causes a decrease in blood platelet count. We retrospectively reviewed the perioperative changes in blood platelet count associated with hepatic resection at a Japanese institution and evaluated the incidence and risk factors for postoperative thrombocytopenia, which may increase the potential risk of epidural hematoma. Methods We analyzed the data of 165 patients who underwent hepatic resection between 1 March 2010 and 30 June 2012 at Hokkaido University Hospital. The criterion of the platelet count for the unsafe removal of epidural catheter was <100,000/μL. Logistic regression was used to model the association between postoperative thrombocytopenia and co-existing liver disease, estimated blood loss and type of hepatic resection. Results After hepatic resection, 42.4 % of patients without preoperative thrombocytopenia experienced thrombocytopenia. The presence of co-existing liver disease was identified as a risk factor for postoperative thrombocytopenia [odds ratio 3.17 (95 % confidence interval 1.63–6.18)]. There was no epidural hematoma in the 149 patients who had epidural anesthesia. Conclusion Hepatic resection can cause postoperative thrombocytopenia that may increase the potential risk of epidural hematoma associated with catheter removal, and the presence of co-existing liver disease heightens concerns for postoperative crucial thrombocytopenia.