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Thrombocytosis as an Early Predictor of Complications Following Pancreatic Resection
*Andrew M Blakely, *Jason T Machan, *Steven Reinert, William G Cioffi, Kevin P Charpentier
Rhode Island Hospital/Brown University, Providence, RI

Objective:
To determine if thrombocytosis is the earliest predictor of intra-abdominal complication following pancreatic resection.
Design:
Retrospective review of prospectively-maintained database.
Setting:
Tertiary care center, non-emergent procedures.
Patients:
Consecutive patients of a single surgeon from January 2007 to June 2012.
Interventions:
Partial or total pancreatic resection. Pancreas transplant, abscess drainage, aborted resection, pseudocystenterostomy, longitudinal pancreaticojejunostomy, and operations performed during acute necrotizing pancreatitis were excluded.
Main Outcome Measures:
Development of thrombocytosis and intra-abdominal complications within 30 days of surgery.
Results:
One hundred seventeen patients underwent pancreatic resection, of whom 61 (52.1%) were male and 62 (53.0%) were at least age 65. Procedures performed were 72 (61.5%) pancreaticoduodenectomy, 42 (32.6%) distal pancreatectomy, and 3 (2.6%) other. Thirty four (29.1%) patients experienced intra-abdominal complications, of which 11 (9.4% overall) were major. Thirty-day mortality was 0.85%, from multi-organ failure. Splenectomy and intra- or post-operative transfusion were considered confounding variables for thrombocytosis. After controlling for splenectomy and transfusion, 53 patients remained, of whom 16 (30.2%) developed intra-abdominal complications. Thrombocytosis, as defined by exceeding normal, rising to 1.5 times the patient’s pre-operative baseline, or two consecutive increases, was associated with and preceded the development of intra-abdominal complications (p=0.0023, OR 7.1, 95% CI [1.9-26.9]), with sensitivity 0.75 and specificity 0.70. Thrombocytosis better predicted complications than fever (sensitivity 0.19, specificity 0.97) or leukocytosis (sensitivity 0.38, specificity 0.76).
Conclusions:
Early thrombocytosis, in absence of splenectomy or blood transfusion, is associated with subsequent diagnosis of intra-abdominal complications following pancreatic resection. Thrombocytosis more reliably predicted the occurrence of intra-abdominal complication than fever or leukocytosis.


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