Thrombocytopenia as an Independent Prognostic Indicator Following Extradural Spinal Tumor Resection.

Objective: Few studies have examined the prognosis for patients with baseline thrombocytopenia undergoing extradural spine tumor resection. Our objective was to evaluate mortality, readmission, and other 30-day outcomes in patients with varying degrees of preoperative thrombocytopenia undergoing osseous extradural tumor excision.

Methods: A multicenter registry was queried for patients treated from 2011-2019. Patients were categorized according to baseline preoperative platelet count, in 25,000/μL increments: 125,000-149,000/μL, 100,000-125,000/μL, 75,000-100,000/μL, and <75,000/μL. These were compared to a control group with platelet count >150,000/μL. Outcomes in each cohort were analyzed using multivariate logistic regression analysis.

Results: The database search revealed 3574 patients undergoing extradural tumor resection; 2171 (60.7%) patients with platelets 125,000-149,000/μL, 114 (3.2%) with 100,000-125,000/μL, 43 (1.2%) with 75,000-100,000/μL, and 42 (1.2%) with <75,000/μL. Platelet counts <100,000/μL was associated with perioperative blood transfusion, cardiac complications, non-home discharge, and 30-day mortality. On subgroup analysis for mortality, an interaction was present between individuals with moderate/severe thrombocytopenia and cervical tumors.

Conclusions: In patients undergoing surgery for extradural spine tumor, degree of baseline thrombocytopenia-rather than presence alone-is an independent predictor of several adverse events. Wherever possible, optimization of preoperative platelet count to at least 100,000/μL may improve outcomes.