Postoperative thrombocytosis as a marker for complications after urologic surgery

Objective. To determine whether thrombocytosis after urologic surgery is a random phenomenon or if it is related to postoperative complications. Material and methods. We evaluated the postoperative course of patients who had a normal platelet count before surgery and developed significant thrombocytosis (platelet count > 500 × 10⁹/l) after surgery during the years 1991-2003. The rate of postoperative complications was compared among patients who did and did not develop thrombocytosis for the three commonest surgical procedures associated with the condition (radical cystectomy, percutaneous nephrolithotripsy and nephrectomy). Results. A total of 179 patients developed thrombocytosis (mean ± SD platelet count 580 ± 105 × 10⁹/l; range 501-1390 × 10⁹/l) after a mean of 13.6 days (SD 14.7 days) following surgery. In 90% of these patients, postoperative complications were diagnosed. The most frequent complications were as follows: urosepsis, n = 49 (27%); hemorrhage, n = 37 (21%); and thromboembolism, n = 15 (8.4%). These complications were diagnosed by means of clinical examination in 114 cases (64%), CT in 31 (17%), Doppler ultrasound in seven (4%) and other diagnostic modalities in nine. In 18 patients (10%), no apparent complication was diagnosed. The rate of postoperative complications was significantly higher among patients who developed thrombocytosis after surgery compared to those who did not (p <0.00001). In 63 patients (35%), the finding of thrombocytosis preceded the diagnosis of the complication (by a median period of 5 days). In these patients, thrombocytosis was essentially an early marker for the impending complication. Conclusions. Postoperative thrombocytosis is not a random phenomenon. It is a serious sign that should not be ignored. Septic and thromboembolic complications should be actively sought by means of thorough clinical evaluation. CT of the abdomen should be considered in appropriate clinical settings. The timing of thrombocytosis and the pathologic spectrum of diseases demonstrated by patients with it justify classifying it as a marker of the subacute phase.