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Observational Study
. 2021 May 27;16(1):27.
doi: 10.1186/s13017-021-00374-z.

Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan

Tadashi Matsuoka  1   2 , Nao Ichihara  3 , Hiroharu Shinozaki  4 , Kenji Kobayashi  4 , Alan Kawarai Lefor  5 , Toshimoto Kimura  6 , Yuko Kitagawa  7 , Yoshihiro Kakeji  8 , Hiroaki Miyata  3   9 , Junichi Sasaki  10
Affiliations
Observational Study

Antithrombotic drugs have a minimal effect on intraoperative blood loss during emergency surgery for generalized peritonitis: a nationwide retrospective cohort study in Japan

Tadashi Matsuoka et al. World J Emerg Surg. .

Abstract

Background: The effect of antithrombotic drugs on intraoperative operative blood loss volume in patients undergoing emergency surgery for generalized peritonitis is not well defined. The purpose of this study was to investigate the effect of antithrombotic drugs on intraoperative blood loss in patients with generalized peritonitis using a nationwide surgical registry in Japan.

Method: This retrospective cohort study used a nationwide surgical registry data from 2011 to 2017 in Japan. Propensity score matching for the use of antithrombotic drugs was used for the adjustment of age, gender, comorbidities, frailty, preoperative state, types of surgery, surgical approach, laboratory data, and others. The main outcome was intraoperative blood loss: comparison of intraoperative blood loss, ratio of intraoperative blood loss after adjusted for confounding factors, and variable importance of all covariates.

Results: A total of 70,105 of the eligible 75,666 patients were included in this study, and 2947 patients were taking antithrombotic drugs. Propensity score matching yielded 2864 well-balanced pairs. The blood loss volume was slightly higher in the antithrombotic drug group (100 [10-349] vs 70 [10-299] ml). After adjustment for confounding factors, the use of antithrombotic drugs was related to a 1.30-fold increase in intraoperative blood loss compared to non-use of antithrombotic drugs (95% CI, 1.16-1.45). The variable importance revealed that the effect of the use of antithrombotic drugs was minimal compared with surgical approach or type of surgery.

Conclusion: This study shows that while taking antithrombotic drugs is associated with a slight increase in intraoperative blood loss in patients undergoing emergency surgery for generalized peritonitis, the effect is likely of minimal clinical significance.

Keywords: Antithrombotic drug; Emergency gastrointestinal surgery; Generalized peritonitis; Intraoperative blood loss.

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Conflict of interest statement

T.M., H.S., K.K., A.K.L., T.K., Y.K., Y.K., and J.S. declare no competing interests.

N.I. and H.M. are affiliated with the Department of Healthcare Quality Assessment, which is a social collaboration department at the University of Tokyo supported by National Clinical Database, Johnson & Johnson K.K., and Nipro Corporation.

Figures

Fig. 1
Fig. 1
Study population
Fig. 2
Fig. 2
Comparison of intraoperative blood loss for antithrombotic drug use (box plot). A Before matching. B After matching. *p < 0.05 compared with the control group as analyzed using Mann-Whitney U test. AT, antithrombotic drug group. The horizontal line in the middle of each box is the median; box length is the interquartile range; whiskers represent the range of the data within the 10th and 90th percentiles
Fig. 3
Fig. 3
Relative importance of each covariate in predicting intraoperative blood loss by the variable importance method. Permutation variable importance was defined as a decrease in the model accuracy caused by permutation of an independent variable. All variables had statistically significant importance. eGFR, estimated glomerular filtration rate; BMI, body mass index; Cre, creatinine; PS-ASA, performance status classification by American Society of Anesthesiologist; ALT, alanine aminotransferase; CRP, C-reactive protein; ALP, alkaline phosphatase; BUN, blood urea nitrogen; APTT, activated partial thromboplastin time; AKI, acute kidney injury; ADL, activities of daily living; WBC, white blood cell; CKD, chronic kidney disease; AST, aspartate aminotransferase; CHF, congestive heart failure; Na, serum sodium; COPD, chronic obstructive pulmonary disease; PCI, percutaneous coronary intervention
Fig. 4
Fig. 4
Distribution of intraoperative blood loss in the entire without matching. A By major procedure type and surgical approach. B By major procedure type and use of antithrombotic drugs. The horizontal line in the middle of each box represents the median; box length represents the interquartile range; whiskers represent the range of within the 10th and 90th percentiles
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