Title

Predictive Factors for Successful Laparoscopic Splenectomy in Patients with Immune Thrombocytopenic Purpura

Document Type

Journal Article

Publication Date

1-1-2004

Journal

Archives of Surgery

Volume

139

Issue

1

DOI

10.1001/archsurg.139.1.61

Abstract

Hypothesis: Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS). Design: Case series. Setting: Private, tertiary care referral center. Patients: Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001. Interventions: Laparoscopic splenectomy. Main Outcome Measures: A successful response to LS was defined as a postoperative platelet count greater than 100 × 103/μL without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 × 103/μL without mdical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 × 10 3/μL, but thrombocytopenia subsequently recurred. Results: Both univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P=.005) and had a higher preoperative platelet count (P=.005). In multivariate analysis, younger age (P=.005) and a higher preoperative platelet count (P=.007) again predicted a successful response to LS. Conclusions: A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 × 103/μL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.

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