Co-existing liver disease increases the risk of postoperative thrombocytopenia in patients undergoing hepatic resection: implications for the risk of epidural hematoma associated with the removal of an epidural catheter.

Purpose: A common surgical diagnosis for hepatic resection in Japan is hepatocellular carcinoma secondary to chronic viral hepatitis. It is known that chronic liver disease causes a decrease in blood platelet count. We retrospectively reviewed the perioperative changes in blood platelet count associated with hepatic resection at a Japanese institution and evaluated the incidence and risk factors for postoperative thrombocytopenia, which may increase the potential risk of epidural hematoma.

Methods: We analyzed the data of 165 patients who underwent hepatic resection between 1 March 2010 and 30 June 2012 at Hokkaido University Hospital. The criterion of the platelet count for the unsafe removal of epidural catheter was <100,000/μL. Logistic regression was used to model the association between postoperative thrombocytopenia and co-existing liver disease, estimated blood loss and type of hepatic resection.

Results: After hepatic resection, 42.4 % of patients without preoperative thrombocytopenia experienced thrombocytopenia. The presence of co-existing liver disease was identified as a risk factor for postoperative thrombocytopenia [odds ratio 3.17 (95 % confidence interval 1.63-6.18)]. There was no epidural hematoma in the 149 patients who had epidural anesthesia.

Conclusion: Hepatic resection can cause postoperative thrombocytopenia that may increase the potential risk of epidural hematoma associated with catheter removal, and the presence of co-existing liver disease heightens concerns for postoperative crucial thrombocytopenia.