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J Arthroplasty. 2019 Apr 18. pii: S0883-5403(19)30344-4. doi: 10.1016/j.arth.2019.04.012. [Epub ahead of print]

Abnormally High, as Well as Low, Preoperative Platelet Counts Correlate With Adverse Outcomes and Readmissions After Elective Total Knee Arthroplasty.

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Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Vanderbilt University School of Medicine, Nashville, Tennessee.



Laboratory studies are routinely performed as a part of the preoperative workup for a total knee arthroplasty (TKA). The ramifications of abnormal preoperative platelet counts remain uncharacterized in large, multicenter patient populations.


Patients who underwent elective primary TKA were identified in the 2011-2015 National Surgical Quality Improvement Program database. Risk of 30-day postoperative complications was calculated as a function of preoperative platelet counts. Patients were characterized as having a normal platelet count, abnormally low platelet count, and abnormally high platelet count based on relative risk calculations. Univariate and multivariate analyses were performed to associate abnormal platelet counts with patient demographics, operative variables, 30-day postoperative complications, and readmissions.


In total, 140,073 patients who underwent elective TKA were identified. Using the relative risk threshold of 1.5 for any adverse event, abnormally low and abnormally high platelet count thresholds were set at ≤116,000/mL and ≥492,000/mL, respectively. Multivariate analyses revealed low platelet counts to be associated with higher rates of any, major, and minor adverse events and longer length of stay. Analogously, high platelet counts were associated with higher rates of any and minor adverse events and longer length of stay.


The present study employed a large patient sample size and showed that elective TKA patients with abnormally high, as well as low, platelet counts are at increased risk of postoperative adverse outcomes. Focused attention needs to be paid to TKA patients with preoperative abnormal platelet counts for optimization and postoperative care.


Level III, retrospective comparative study.


platelet count; postoperative adverse events; readmission; surgical outcomes; the American College of Surgeons National Surgical Quality Improvement Program; total knee arthroplasty


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