How Does Thrombocytopenia Affect Outcomes in Head and Neck Cancer Surgery With Free Flap Reconstruction?

[BACKGROUND] Thrombocytopenia is associated with a variety of medical comorbidities seen in patients with head and neck cancer. However, it remains unclear if and how thrombocytopenia affects surgical outcomes.

[PURPOSE] The purpose of this study was to measure the association between thrombocytopenia and 30-day adverse outcomes in patients undergoing head and neck cancer surgery with free flap reconstruction.

[STUDY DESIGN, SETTING SAMPLE] This was a retrospective cohort study using the 2012 to 2022 American College of Surgeons National Surgical Quality Improvement Program databases. Patients undergoing resection and free flap reconstruction for malignant pathology of the oral cavity, oropharynx, hypopharynx, larynx, and salivary glands were included. Patients undergoing emergency surgery or with missing outcomes data were excluded.

[PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE] The predictor variable was platelet count coded as a binary variable: <150k/μL (thrombocytopenia) or >150k/μL.

[MAIN OUTCOME VARIABLE] The primary outcome variable was return to the operating room for free flap salvage or hematoma evacuation coded based on International Classification of Diseases diagnoses.

[COVARIATES] Covariates were categorized into demographic (age, sex), medical (hypertension, diabetes), and perioperative (concurrent procedures, reconstructive modality).

[ANALYSES] Descriptive, bivariate, and bootstrapped multiple logistic regression statistics were performed to evaluate the association between thrombocytopenia and adverse outcomes. Youden J analysis was used to identify a platelet value at which complications were more likely to occur. An alpha of P < .05 was significant.

[RESULTS] A total of 4,993 subjects met the inclusion criteria. There were 281 subjects with thrombocytopenia (5.63%) and 213 who underwent reoperations (4.30%). In bivariate analysis, thrombocytopenia was the only significant risk factor for reoperation, and these subjects were 1.74 times more likely to return to the operating room (P = .015, relative risk = 1.74, 95% CI 1.11 to 2.71). In multivariate analysis adjusting for study covariates, thrombocytopenia was independently associated with 1.82 times greater odds of return to the operating room (P = .026, OR = 1.82, 95% CI 1.11 to 3.26). Cut point analysis suggested that a platelet value less than 136,000/μL was a risk factor for return to the operating room.

[CONCLUSIONS AND RELEVANCE] Thrombocytopenia was independently associated with return to the operating room following ablative head and neck cancer procedures with free flap reconstruction.