PLATELET COUNT AND THE OUTCOME OF OPERATION FOR RUPTURED ABDOMINAL AORTIC-ANEURYSM

Purpose: The purpose of this study was to determine the relationship b etween admission and postoperative platelet count (PC) and mortality a nd morbidity rates after emergency surgery for ruptured abdominal aort ic aneurysm (AAA). Methods: We performed a case record review of 65 co nsecutive patients admitted with ruptured AAA. Results: Five patients did not undergo operation because of poor clinical condition, 12 patie nts died at operation, 13 patients died after operation, and 35 patien ts survived (operative mortality rate of 58%). Fifteen patients had an admission PC of less than 150 x 10(9)/L, of whom 14 (93%) died; 27 pa tients had an admission PC of 150 to 250 x 10(9)/L, of whom 8 (30%) di ed; and 18 patients had an admission PC of greater than 250 x 10(9)/L of whom 3 (17%) died. At the end of operation 29 patients had a PC of less than 100 x 10(9)/L, of whom 13 (45%) died, 20 (69%) had developme nt of multiorgan failure (MOF), and 6 (21%) required relaparotomy for bleeding complications. By contrast, all 19 patients having a PC of 10 0 x 10(9)/L or greater at the end of the operation survived, three (16 %) had development of MOP, and none required further surgery for bleed ing. There was a significant inverse correlation between PC at the end of the operation and the number of postoperative days spent on a vent ilator, in the intensive therapy unit, and in hospital. After operatio n, 15 patients had development of thrombocytosis (PC > 400 x 10(9)/L), of whom 10 had development of deep venous thrombosis and 8 had develo pment of pulmonary embolism. There were no deep venous thromboses or p ulmonary embolisms in patients who did not have development of a posto perative thrombocytosis. Conclusions: There is a direct correlation be tween PC on admission to the hospital and death after emergency repair of ruptured AAA. Thrombocytopenia at the end of the operation is asso ciated with a high risk of morbidity from continuing hemorrhage or MOF . The development of postoperative thrombocytosis is associated with a high risk of thromboembolic complications. PC provides a simple marke r of outcome in patients diagnosed with and undergoing operation for r uptured AAA.