Medical History and Preoperative Coagulation Profile as Predictors of Outcomes in Elective Neurosurgery: A Meta-Analysis of 78,909 patients

Abstract

Introduction: In patients with unremarkable medical history, the role of comprehensive preoperative hemostasis screening in elective neurosurgical procedures remains debated. Comprehensive medical history has shown to be non-inferior to coagulation profile to evaluate surgical outcomes. This study aims to evaluate the predictiveness of preoperative coagulation screening and medical history for surgical outcomes. Objective: We conducted a meta-analysis to analyze the predictiveness of preoperative hemostasis screening and clinical history for patient outcomes in elective neurosurgical procedures. Methods: Databases were searched until April 22nd 2023 for observational cohort studies that reported preoperative hemostasis screening and clinical history prior to elective neurosurgical procedures. Outcomes of interest included postoperative transfusion, mortality, and complications. Pooled relative risk ratios (RR) were analyzed using random-effects models. Results: Out of 604 studies, 3 cohort studies with a patient population of 78,909 met our inclusion criteria. Prolonged PTT (RR=1.42, 95%CI=1.14-1.77, p=0.002), elevated INR (RR=2.01, 95%CI=1.14-3.55, p=0.02), low platelet count (RR=1.58, 95%CI=1.34-1.86, p<0.00001), and positive bleeding history (RR=2.14, 95%CI=1.16-3.93, p=0.01) were associated with postoperative transfusion risk. High PTT (RR=2.42, 95%CI=1.24-4.73, p=0.010), High INR (RR=8.15, 95%CI=5.97-11.13, p<0.00001), low platelet count (RR=4.89, 95%CI=3.73-6.41, p<0.00001), and bleeding history (RR=7.59, 95%CI=5.84-9.86, p<0.00001) were predictive of mortality. Prolonged PTT (RR=1.53, 95%CI=1.25,1.86; p=<0.0001), a high INR (RR=3.41, 95%CI=2.63,4.42; p=< 0.00001), low platelets (RR=1.63, 95%CI=1.40,1.90; p=<0.00001), and medical history (RR=2.15, 95%CI=1.71,2.71; p=<0.00001) were predictive of complications. Conclusion: Medical history was a non-inferior predictor to coagulation profile for postoperative transfusion, mortality, and complications in elective neurosurgery. Standardized clinical risk stratification tools, and cost-effective alternatives should be explored to promote affordable-patient care.