Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura

Hypothesis: Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS). Design Case series. Setting Private, tertiary care referral center. Patients Sixty-seven consecutive patients undergoing LS for ITP between 1995 and 2001. Interventions Laparoscopic splenectomy. Main Outcome Measures A successful response to LS was defined as a postoperative platelet count greater than 100 x 103/\ub5L without medical therapy. Failures were classified as recurrent or refractory. Patients considered refractory to surgery did not achieve a platelet count greater than 100 x 103/\ub5L without medical therapy. Patients with recurrent ITP initially achieved a platelet count greater than 100 x 103/\ub5L, but thrombocytopenia subsequently recurred. Results: Both univariate and multivariate analyses were performed for 13 preoperative variables to identify factors predictive of success following LS. At a mean follow up of 22 months, 43 patients (64%) had a successful response to LS, 14 (21%) were refractory, and 10 (15%) developed recurrent ITP. By univariate analysis, patients responding to laparoscopic splenectomy were younger (P =3D .005) and had a higher preoperative platelet count (P =3D .005). In multivariate analysis, younger age (P =3D .005) and a higher preoperative platelet count (P =3D .007) again predicted a successful response to LS. Conclusions: A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 103/\ub5L. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP