B0503 - Mild Thrombocytopenia as a Predictor of Surgical Outcomes Following Cholecystectomy: A Tool for Perioperative Assessment in Patients With Non-Alcoholic Fatty Liver Disease?

Award: Presidential Poster Award

Bryce Schutte, DO¹, William S. Reiche, DO¹, Haitam Buaisha, MD², Ryan Walters, PhD^2
1CHI Creighton University Medical Center, Omaha, NE; ²Creighton University School of Medicine, Omaha, NE

Introduction: As evidenced by its inclusion in estimations of liver fibrosis, thrombocytopenia is a well-defined abnormality in chronic hepatic disease. Studies show that platelet counts fewer than 160 x 109/L are an independent marker for severity of hepatic fibrosis. Non-alcoholic fatty liver disease (NAFLD) is now the most prevalent liver disorder in Western countries making characterization of morbidity increasingly important. There is a paucity of information available to characterize perioperative risk for patients with NAFLD. We used a threshold of 150 x 109 as a surrogate for NAFLD in patients undergoing laparoscopic cholecystectomy to study its effect on perioperative complications and mortality.

Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for cholecystectomies occurring from 2005 through 2018. Demographic differences between patients with and without thrombocytopenia were evaluated using the t-test or the chi-square test, whereas differences in outcome risk was evaluated using log-binomial regression models.

Results: We identified 437,630 patients who underwent cholecystectomy, of whom 6.9% had thrombocytopenia. Patients with thrombocytopenia were more often male, older, with chronic disease. As shown in Table 1 and Figure 1, patients with thrombocytopenia had higher 30-day mortality rates risk ratio (RR) 5.3 (95% CI: 4.8-5.9) and higher complication rates RR 2.4 (95% CI: 2.3-2.5). The most frequent complications included respiratory, need for transfusion, and renal.

Discussion: Peri-operatively, patients with mild thrombocytopenia undergoing cholecystectomy had higher mortality rates and complications compared to patients with normal platelet counts, and this effect continued as thrombocytopenia became more pronounced. Other etiologies of mild thrombocytopenia could not be excluded; however, aside from cancer (a small proportion) these are unlikely to affect clinical outcomes. Currently, most society guidelines including the AASLD practice guidance do not recommend NAFLD screening in the general population even among high-risk patients with diabetes or obesity. Thrombocytopenia might be a promising, cost-effective tool for NAFLD screening especially if used in high-risk populations (male gender, hypertension or diabetes, with or without high BMI). Furthermore, our study suggests that platelet counts may have utility in predicting peri-operative outcomes in this population.




Disclosures:


Bryce Schutte, DO¹, William S. Reiche, DOsup>1, Haitam Buaisha, MD², Ryan Walters, PhD². B0503 - Mild Thrombocytopenia as a Predictor of Surgical Outcomes Following Cholecystectomy: A Tool for Perioperative Assessment in Patients With Non-Alcoholic Fatty Liver Disease?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.