Univariate and multivariable analysis of risk factors for 90-day postoperative HFS and CFS among 354 surgical events in patients with MPN
| MPN subtype and variable . | HFS . | CFS . | ||
|---|---|---|---|---|
| Univariate P value (HR, 95% CI) . | Multivariable P value (HR, 95% CI) . | Univariate P value (HR, 95% CI) . | Multivariable P value (HR, 95% CI) . | |
| PV | ||||
| Age at time of surgery, y | .76 | .61 | ||
| Male | .48 1.4 (0.5-4) | .33 1.6 (0.6-4.1) | ||
| Presence of 2+ (vs 0-1) cardiovascular risk factors∗ | .9 0.9 (0.3-2.5) | .79 1.1 (0.4-2.9) | ||
| Leukocyte count ≥11 × 109/L | .01 3.4 (1.2-9.6) | .05 3 (0.9-9.8) | .007 3.6 (1.4-9.4) | .06 2.8 (0.9-8.4) |
| Hct >45% | .8 1.2 (0.32-4.1) | .56 1.4 (0.5-4.3) | ||
| Hct <35% | .0004 7.3 (2.6-20.2) | .03 3.8 (1.1-12.6) | .0004 6.3 (2.5-15.9) | .04 3.5 (1.1-11.4) |
| PLT count >450 × 109/L | .3 0.4 (0.05-2.9) | .8 1.2 (0.3-4.1) | ||
| History of thrombosis at or before surgery | .3 0.5 (0.14-1.9) | .8 1.1 (0.4-3) | ||
| History of complication in a prior surgery† | .7‡ | .07 12.9 (1.4-116) | ||
| Major vs minor procedure | .6 1.3 (0.4-3.8) | .7 1.2 (0.5-3.3) | ||
| Urgent/semiurgent vs elective | .04 2.8 (1-7.8) | .35 | .02 3 (1.2-7.8) | .9 |
| General anesthesia | .01 4.0 (1.3-12.7) | .5 | .12 2.1 (0.8-5.5) | |
| Discontinuation of antiplatelet at surgery | .2 2.0 (0.7-6.3) | .24 1.8 (0.7-4.8) | ||
| Cytoreduction at surgery (ruxolitinib vs hydroxyurea) | .05 4.8 (1.2-19.3) | .07 4 (1-15.7) | .5 | |
| Modification of cytoreduction at surgery (stop/modify vs continue) | .005 5.4 (1.7-16.9) | .77 | .006 5.1 (1.6-16.2) | .5 |
| Postoperative thromboprophylaxis | .0004 7.7 (2.5-23.8) | .004 6 (1.8-20) | .002 5.3 (1.9-14.6) | .03 3.5 (1-10.9) |
| ET | ||||
| Age at time of surgery, y | .03‡ | .5 | .5‡ | |
| Male | .51 1.81 (0.3-10.9) | .18 2.5 (0.6-9.7) | ||
| Driver mutation status CALR vs JAK2 | .008 12.9 (1.5-116) | .003 19 (2.1-180) | .1 3.3 (0.8-13.1) | |
| Presence of 2+ (vs 0-1) cardiovascular risk factors∗ | .7 0.7 (0.1-4.3) | .34 0.5 (0.1-2.1) | ||
| Leukocyte count ≥11 × 109/L | .25‡ | .23‡ | ||
| PLT count, × 109/L | .04 | .05 0.99 (0.99-1) | .12 | |
| PLT count >450 × 109/L | .14 | .04‡ | .02‡ | |
| History of thrombosis at or before surgery | .12 | .05 3.68 (1-13.7) | .99 | |
| History of complication in a prior surgery† | .02 53 (3.2-839) | .04 26 (2.4-287) | ||
| Major vs minor procedure | .75 1.42 (0.16-12.8) | .03 4.8 (1.3-17.9) | .009‡ | |
| Urgent/semiurgent vs elective | .001 22.4 (2.5-200) | .007 17.5 (1.8-172) | .0004 11.6 (2.9-46.3) | .00003‡ |
| General anesthesia | .86 | .49 1.8 (0.36-8.73) | ||
| Absence of routine antiplatelet therapy before surgery | .03 7.7 (1.3-45.8) | .71 | .04 4.1 (1.1-15.3) | .02‡ |
| Discontinuation of antiplatelet therapy at surgery (those on therapy) | .14‡ | .01‡ | .99 | |
| Cytoreduction at surgery | .14 | .16 | ||
| Modification of cytoreduction at surgery (stop/modify vs continue) | .3 3.9 (0.4-43.7) | .09 5.3 (0.9-31.8) | ||
| Postoperative thromboprophylaxis | .11 6.51 (0.6-71.9) | .03 9.9 (1.1-96) | .001‡ | |
| MF | ||||
| Age at time of surgery, y | .13 | .6 | ||
| Male | .36 2.5 (0.29-20.9) | .16 3.5 (0.44-28.2) | ||
| Driver mutation CALR vs JAK2 | .5 2.2 (0.2-21.2) | .24 2.9 (0.5-16.3) | ||
| Presence of 2+ (vs 0-1) cardiovascular risk factors∗ | .06‡ | .41 | .36 0.42 (0.05-3.3) | |
| Leukocyte count ≥11 × 109/L | .8 0.9 (0.2-3.4) | .99 1.0 (0.3-3.29) | ||
| Hct <35 % | .69 0.74 (0.2-3.1) | .8 1.2 (0.3-4.5) | ||
| PLT count <150 × 109/L | .4 1.9 (0.5-7.7) | .14 2.5 (0.7-8.2) | ||
| PLT count >450 × 109/L | .54 1.7 (0.3-8.5) | .9 1.1 (0.24-5.3) | ||
| History of thrombosis at or before surgery | .2 3.4 (0.6-17.5) | .09 3.6 (0.9-14) | ||
| History of complication in a prior surgery† | .28 4 (0.5-36) | .003 15.5 (3.4-72) | ||
| Major vs minor procedure | .36 2.2 (0.4-11) | .18 2.7 (0.71-10.2) | ||
| Urgent/semiurgent vs elective | .5 0.5 (0.06-4.2) | .63 1.4 (0.4-5.3) | ||
| General anesthesia | .62 0.7 (0.12-3.6) | .57 0.67 (0.16-2.7) | ||
| Absence of routine antiplatelet therapy before surgery | .4 1.8 (0.4-7.7) | .3 2.0 (0.6-6.8) | ||
| Cytoreduction at surgery (ruxolitinib exposure) | .66 1.6 (0.2-13.1) | .02 4.9 (1.1-23.1) | .02 4.9 (1.1-23.1) | |
| Modification of cytoreduction at surgery (stop/modify vs continue) | .02 12.4 (2.2-69.7) | .02 12.4 (2.2-69.7) | .11 4.3 (0.9-20.5) | |
| Postoperative thromboprophylaxis | .6 0.6 (0.06-5.1) | .65 0.7 (0.1-3.5) | ||
| MPN subtype and variable . | HFS . | CFS . | ||
|---|---|---|---|---|
| Univariate P value (HR, 95% CI) . | Multivariable P value (HR, 95% CI) . | Univariate P value (HR, 95% CI) . | Multivariable P value (HR, 95% CI) . | |
| PV | ||||
| Age at time of surgery, y | .76 | .61 | ||
| Male | .48 1.4 (0.5-4) | .33 1.6 (0.6-4.1) | ||
| Presence of 2+ (vs 0-1) cardiovascular risk factors∗ | .9 0.9 (0.3-2.5) | .79 1.1 (0.4-2.9) | ||
| Leukocyte count ≥11 × 109/L | .01 3.4 (1.2-9.6) | .05 3 (0.9-9.8) | .007 3.6 (1.4-9.4) | .06 2.8 (0.9-8.4) |
| Hct >45% | .8 1.2 (0.32-4.1) | .56 1.4 (0.5-4.3) | ||
| Hct <35% | .0004 7.3 (2.6-20.2) | .03 3.8 (1.1-12.6) | .0004 6.3 (2.5-15.9) | .04 3.5 (1.1-11.4) |
| PLT count >450 × 109/L | .3 0.4 (0.05-2.9) | .8 1.2 (0.3-4.1) | ||
| History of thrombosis at or before surgery | .3 0.5 (0.14-1.9) | .8 1.1 (0.4-3) | ||
| History of complication in a prior surgery† | .7‡ | .07 12.9 (1.4-116) | ||
| Major vs minor procedure | .6 1.3 (0.4-3.8) | .7 1.2 (0.5-3.3) | ||
| Urgent/semiurgent vs elective | .04 2.8 (1-7.8) | .35 | .02 3 (1.2-7.8) | .9 |
| General anesthesia | .01 4.0 (1.3-12.7) | .5 | .12 2.1 (0.8-5.5) | |
| Discontinuation of antiplatelet at surgery | .2 2.0 (0.7-6.3) | .24 1.8 (0.7-4.8) | ||
| Cytoreduction at surgery (ruxolitinib vs hydroxyurea) | .05 4.8 (1.2-19.3) | .07 4 (1-15.7) | .5 | |
| Modification of cytoreduction at surgery (stop/modify vs continue) | .005 5.4 (1.7-16.9) | .77 | .006 5.1 (1.6-16.2) | .5 |
| Postoperative thromboprophylaxis | .0004 7.7 (2.5-23.8) | .004 6 (1.8-20) | .002 5.3 (1.9-14.6) | .03 3.5 (1-10.9) |
| ET | ||||
| Age at time of surgery, y | .03‡ | .5 | .5‡ | |
| Male | .51 1.81 (0.3-10.9) | .18 2.5 (0.6-9.7) | ||
| Driver mutation status CALR vs JAK2 | .008 12.9 (1.5-116) | .003 19 (2.1-180) | .1 3.3 (0.8-13.1) | |
| Presence of 2+ (vs 0-1) cardiovascular risk factors∗ | .7 0.7 (0.1-4.3) | .34 0.5 (0.1-2.1) | ||
| Leukocyte count ≥11 × 109/L | .25‡ | .23‡ | ||
| PLT count, × 109/L | .04 | .05 0.99 (0.99-1) | .12 | |
| PLT count >450 × 109/L | .14 | .04‡ | .02‡ | |
| History of thrombosis at or before surgery | .12 | .05 3.68 (1-13.7) | .99 | |
| History of complication in a prior surgery† | .02 53 (3.2-839) | .04 26 (2.4-287) | ||
| Major vs minor procedure | .75 1.42 (0.16-12.8) | .03 4.8 (1.3-17.9) | .009‡ | |
| Urgent/semiurgent vs elective | .001 22.4 (2.5-200) | .007 17.5 (1.8-172) | .0004 11.6 (2.9-46.3) | .00003‡ |
| General anesthesia | .86 | .49 1.8 (0.36-8.73) | ||
| Absence of routine antiplatelet therapy before surgery | .03 7.7 (1.3-45.8) | .71 | .04 4.1 (1.1-15.3) | .02‡ |
| Discontinuation of antiplatelet therapy at surgery (those on therapy) | .14‡ | .01‡ | .99 | |
| Cytoreduction at surgery | .14 | .16 | ||
| Modification of cytoreduction at surgery (stop/modify vs continue) | .3 3.9 (0.4-43.7) | .09 5.3 (0.9-31.8) | ||
| Postoperative thromboprophylaxis | .11 6.51 (0.6-71.9) | .03 9.9 (1.1-96) | .001‡ | |
| MF | ||||
| Age at time of surgery, y | .13 | .6 | ||
| Male | .36 2.5 (0.29-20.9) | .16 3.5 (0.44-28.2) | ||
| Driver mutation CALR vs JAK2 | .5 2.2 (0.2-21.2) | .24 2.9 (0.5-16.3) | ||
| Presence of 2+ (vs 0-1) cardiovascular risk factors∗ | .06‡ | .41 | .36 0.42 (0.05-3.3) | |
| Leukocyte count ≥11 × 109/L | .8 0.9 (0.2-3.4) | .99 1.0 (0.3-3.29) | ||
| Hct <35 % | .69 0.74 (0.2-3.1) | .8 1.2 (0.3-4.5) | ||
| PLT count <150 × 109/L | .4 1.9 (0.5-7.7) | .14 2.5 (0.7-8.2) | ||
| PLT count >450 × 109/L | .54 1.7 (0.3-8.5) | .9 1.1 (0.24-5.3) | ||
| History of thrombosis at or before surgery | .2 3.4 (0.6-17.5) | .09 3.6 (0.9-14) | ||
| History of complication in a prior surgery† | .28 4 (0.5-36) | .003 15.5 (3.4-72) | ||
| Major vs minor procedure | .36 2.2 (0.4-11) | .18 2.7 (0.71-10.2) | ||
| Urgent/semiurgent vs elective | .5 0.5 (0.06-4.2) | .63 1.4 (0.4-5.3) | ||
| General anesthesia | .62 0.7 (0.12-3.6) | .57 0.67 (0.16-2.7) | ||
| Absence of routine antiplatelet therapy before surgery | .4 1.8 (0.4-7.7) | .3 2.0 (0.6-6.8) | ||
| Cytoreduction at surgery (ruxolitinib exposure) | .66 1.6 (0.2-13.1) | .02 4.9 (1.1-23.1) | .02 4.9 (1.1-23.1) | |
| Modification of cytoreduction at surgery (stop/modify vs continue) | .02 12.4 (2.2-69.7) | .02 12.4 (2.2-69.7) | .11 4.3 (0.9-20.5) | |
| Postoperative thromboprophylaxis | .6 0.6 (0.06-5.1) | .65 0.7 (0.1-3.5) | ||
CALR, calreticulin; CI, confidence interval; HR, hazard ratio; JAK2, Janus kinase 2.
Cardiovascular risk factors defined as: arterial hypertension, hyperlipidemia, diabetes requiring treatment, and active smoking.
Analysis limited to patients who underwent multiple interventions.
HR and CI were not computable because there were an insufficient number of events for comparison. P values in bold are statistically significant.