B. C. Gulack1, B. R. Englum1, D. D. Lo1, D. P. Nussbaum1, J. E. Keenan1, J. E. Scarborough1, M. L. Shapiro1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction: There is little data currently available to guide surgical decision making regarding emergent surgical interventions on leukopenic patients. The purpose of this study was to investigate the impact of leukopenia among patients undergoing emergency abdominal operations in order to better guide preoperative patient discussions.
Methods: The 2005-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients who underwent emergent laparotomy. Patients were stratified by pre-operative white blood cell count (4.0-12.0 vs. <4.0). Baseline demographics, comorbidities, and outcomes were compared. Multivariable logistic regression was performed to estimate the independent association between leukopenia and mortality taking into account the robust array of patient-related factors.
Results: 22,097 patients met inclusion criteria, 2,252 (5.5%) of whom were leukopenic prior to surgery. There were notable differences between groups including baseline functional status, ASA class, steroid use, pre-operative chemotherapy/radiation, and pre-operative sepsis among others. Unadjusted comparison demonstrated significantly increased organ space infections (6.8% vs 4.6%, p <0.001), post-operative pneumonia (11.9% vs. 8.4%, p <0.001), prolonged mechanical ventilation (31.4% vs. 16.3%, p <0.001), new onset post-operative dialysis requirement (2.1% vs. 1.3%, p <0.001), hospital length of stay (10 vs. 8 days, p <0.001), and 30-day mortality (27.8% vs. 12.8%, p <0.001) in the leukopenia group (Figure). After multivariable adjustment for patient-related factors, leukopenia was maintained as a significant predictor of mortality.
Conclusion: Leukopenia is an independent predictor of mortality in patients undergoing emergent laparotomy. Understanding the risk of complications and mortality associated with these procedures is pertinent for pre-operative patient discussions.
