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Thrombocytopenia Associated with Unrecognized Non-Alcoholic Fatty Liver Disease Is an Independent Predictor of Perioperative Significant Blood Loss in Cervical Laminoplasty

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Title: Thrombocytopenia Associated with Unrecognized Non-Alcoholic Fatty Liver Disease Is an Independent Predictor of Perioperative Significant Blood Loss in Cervical Laminoplasty
Authors: Suzuki, Ryota Browse this author
Koike, Yoshinao Browse this author
Ota, Masahiro Browse this author
Endo, Tsutomu Browse this author
Hisada, Yuichiro Browse this author
Tsujimoto, Takeru Browse this author
Kanayama, Masahiro Browse this author
Ito, Yoichi M. Browse this author
Sudo, Hideki Browse this author
Iwata, Akira Browse this author
Yamada, Katsuhisa Browse this author
Iwasaki, Norimasa Browse this author →KAKEN DB
Takahata, Masahiko Browse this author →KAKEN DB
Keywords: Cervical laminoplasty
Liver fibrosis
Non-alcoholic fatty liver disease
Ossification of the posterior longitudinal ligament
Significant blood loss
Issue Date: Nov-2021
Publisher: Elsevier
Journal Title: World neurosurgery
Volume: 155
Start Page: E797
End Page: E804
Publisher DOI: 10.1016/j.wneu.2021.09.012
Abstract: OBJECTIVE: To identify risk factors for significant blood loss (SBL) in cervical laminoplasty, especially regarding thrombocytopenia and coagulopathy resulting from nonalcoholic fatty liver disease (NAFLD). METHODS: We retrospectively investigated differences in patient background data, laboratory data at the time of admission, and surgery-related data of 317 patients who underwent cervical laminoplasty and were divided into SBL (estimated blood loss [EBL] + drainage [D] 2500 g) and non-SBL (EBL + D < 500 g) groups. To evaluate liver status, we used the fibrous 4 index and considered fibrous 4 index >= 1.85 as a representative phenotype for NAFLD with liver fibrosis. In addition, the risk factor for perioperative SBL was investigated using multiple logistic regression analysis, and the cutoff value was calculated. RESULTS: Incidence of perioperative SBL in cervical laminoplasty was 7.3% (23/317). Compared with the non-SBL group, the SBL group demonstrated significantly lower platelet count (PIT), lower aspartate aminotransferase, longer operation time, and greater number of opened laminae. According to multivariate analysis, lower PLT and a greater number of opened laminae were identified as significant risk factors for perioperative SBL. The cutoff value of PLT for predicting SBL was determined to be 16.7 x 10(4)/mu L using a receiver operating characteristic curve. The liver fibrosis group revealed significantly lower PLT and greater EBL + D than the non-liver fibrosis group. CONCLUSIONS: Thrombocytopenia is an independent predictor of perioperative SBL in cervical laminoplasty. Thus, patients with mild thrombocytopenia that may be associated with NAFLD must be carefully monitored to avoid perioperative SBL.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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