P. P. Patel1, J. H. Weller1, C. R. Westermann1, D. S. Rhee1 1Johns Hopkins University School Of Medicine,Department Of Pediatric Surgery,Baltimore, MD, USA
Introduction:
Children undergoing cancer treatment often develop leukopenia, which may impair wound healing and increase surgical complication rates. In leukopenic children who develop an acute surgical process, the optimal management strategy remains unclear. This study examined the effect of preoperative leukopenia on postoperative outcomes in children treated for cancer who underwent an appendectomy or cholecystectomy.
Methods:
This was a retrospective cohort study of pediatric cancer patients in the National Surgical Quality Improvement Program-Pediatric database from 2012-2018. Patients <18 years old with any active cancer who underwent an appendectomy or cholecystectomy were included. Children receiving other major concurrent operations were excluded. Patient demographics and perioperative characteristics were compared by leukopenia status (WBC <4 vs. ≥4 x 10^3/mL) using chi-squared and Kruskal-Wallis tests for categorical variables and Mann-Whitney U tests for continuous variables. Primary outcomes of 30-day composite complications, including infections, reoperations, and readmissions, as well as postoperative length of stay (LOS) were analyzed by leukopenia status for each procedure using multivariate logistic and log-transformed linear regression.
Results:
A total of 328 children met inclusion criteria, with 227 (69.2%) appendectomy and 101 (30.8%) cholecystectomy cases. Children were typically male (n=202, 61.6%) and white (n=243, 74.0%) with a median age at operation of 12 years (IQR 8.7-15.1). Leukopenia was seen in 93 (41.0%) appendectomies and 57 (56.4%) cholecystectomies. There were no significant differences in operative time or use of laparoscopy by leukopenic status for either procedure. Nineteen (8.4%) appendectomy patients developed a postoperative complication as compared to six (5.9%) cholecystectomy patients. The mean postoperative LOS was 4.5 days (SD 5.9) for appendectomies and 3 days (SD 4.8) for cholecystectomies. After multivariate analyses, leukopenia was not associated with an increase in postoperative complications for children undergoing appendectomies (OR 0.55, p=0.36) or cholecystectomies (OR 0.39, p=0.37). There was also no significant different in postoperative LOS for patients with versus without leukopenia who underwent an appendectomy (1.27 days, p=0.15) or cholecystectomy (1.08 days, p=0.71).
Conclusion:
In children with active cancer, leukopenia was not associated with increased short-term postoperative complications or longer postoperative LOS after either an appendectomy or cholecystectomy. This suggests delaying procedures for leukopenia in this population might not be necessary.
