BACKGROUND: There are little data currently available to guide surgical decision making regarding emergent surgical interventions in leukopenic patients. The purpose of this study was to investigate the impact of leukopenia among patients undergoing emergency abdominal operations to better guide preoperative decision making. METHODS: The 2005 to 2012 American College of Surgeons' National Surgical Quality Improvement Program database was queried to identify patients who underwent emergent laparotomy. Patients were stratified by preoperative white blood cell (WBC) count (<4.0 × 10(9)/L vs. 4.0-12.0 × 10(9)/L). Baseline demographics, comorbidities, and outcomes were compared. Multivariable logistic regression was performed to estimate the adjusted association between leukopenia and mortality, taking into account the robust array of patient-related factors. RESULTS: Of the 20,443 patients who met study criteria, 2,057 (8.2%) were leukopenic (WBC < 4.0) before surgery. Unadjusted comparison demonstrated significantly increased major morbidity (45.4% vs. 26.9%, p < 0.001) as well as mortality (24.4% vs. 10.8%, p < 0.001) for patients with leukopenia compared with patients with a normal preoperative WBC count. Only 46.0% (n = 947) of patients with leukopenia before surgery were able to avoid major morbidity or mortality compared with 69.4% (n = 15,974) of patients with a normal preoperative WBC count (p < 0.001). After multivariable adjustment for patient-related factors, leukopenia was maintained as a significant predictor of mortality. CONCLUSION: Although leukopenia remains associated with mortality in patients undergoing emergent laparotomy despite adjustment for other patient-related factors, it is not necessarily prohibitive. Understanding the risk of complications and mortality associated with these procedures is pertinent for preoperative clinical decision making. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.
BACKGROUND: There are little data currently available to guide surgical decision making regarding emergent surgical interventions in leukopenicpatients. The purpose of this study was to investigate the impact of leukopenia among patients undergoing emergency abdominal operations to better guide preoperative decision making. METHODS: The 2005 to 2012 American College of Surgeons' National Surgical Quality Improvement Program database was queried to identify patients who underwent emergent laparotomy. Patients were stratified by preoperative white blood cell (WBC) count (<4.0 × 10(9)/L vs. 4.0-12.0 × 10(9)/L). Baseline demographics, comorbidities, and outcomes were compared. Multivariable logistic regression was performed to estimate the adjusted association between leukopenia and mortality, taking into account the robust array of patient-related factors. RESULTS: Of the 20,443 patients who met study criteria, 2,057 (8.2%) were leukopenic (WBC < 4.0) before surgery. Unadjusted comparison demonstrated significantly increased major morbidity (45.4% vs. 26.9%, p < 0.001) as well as mortality (24.4% vs. 10.8%, p < 0.001) for patients with leukopenia compared with patients with a normal preoperative WBC count. Only 46.0% (n = 947) of patients with leukopenia before surgery were able to avoid major morbidity or mortality compared with 69.4% (n = 15,974) of patients with a normal preoperative WBC count (p < 0.001). After multivariable adjustment for patient-related factors, leukopenia was maintained as a significant predictor of mortality. CONCLUSION: Although leukopenia remains associated with mortality in patients undergoing emergent laparotomy despite adjustment for other patient-related factors, it is not necessarily prohibitive. Understanding the risk of complications and mortality associated with these procedures is pertinent for preoperative clinical decision making. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III.
Authors: S E Wilson; G Robinson; R A Williams; B E Stabile; L Cone; I J Sarfeh; D R Miller; E Passaro Journal: Ann Surg Date: 1989-10 Impact factor: 12.969
Authors: D B Allen; J J Maguire; M Mahdavian; C Wicke; L Marcocci; H Scheuenstuhl; M Chang; A X Le; H W Hopf; T K Hunt Journal: Arch Surg Date: 1997-09
Authors: T Davidson; T G Allen-Mersh; A J Miles; B Gazzard; C Wastell; M Vipond; A Stotter; R F Miller; N R Fieldman; W W Slack Journal: Br J Surg Date: 1991-08 Impact factor: 6.939
Authors: Michel P J Teuben; Marjolein Heeres; Taco Blokhuis; Roy Spijkerman; Eric Knot; Nienke Vrisekoop; Roman Pfeifer; Hans-Christoph Pape; Leo Koenderman; Luke P H Leenen Journal: Front Immunol Date: 2022-05-17 Impact factor: 8.786
Authors: Federico Coccolini; Mario Improta; Massimo Sartelli; Kemal Rasa; Robert Sawyer; Raul Coimbra; Massimo Chiarugi; Andrey Litvin; Timothy Hardcastle; Francesco Forfori; Jean-Louis Vincent; Andreas Hecker; Richard Ten Broek; Luigi Bonavina; Mircea Chirica; Ugo Boggi; Emmanuil Pikoulis; Salomone Di Saverio; Philippe Montravers; Goran Augustin; Dario Tartaglia; Enrico Cicuttin; Camilla Cremonini; Bruno Viaggi; Belinda De Simone; Manu Malbrain; Vishal G Shelat; Paola Fugazzola; Luca Ansaloni; Arda Isik; Ines Rubio; Itani Kamal; Francesco Corradi; Antonio Tarasconi; Stefano Gitto; Mauro Podda; Anastasia Pikoulis; Ari Leppaniemi; Marco Ceresoli; Oreste Romeo; Ernest E Moore; Zaza Demetrashvili; Walter L Biffl; Imitiaz Wani; Matti Tolonen; Therese Duane; Sameer Dhingra; Nicola DeAngelis; Edward Tan; Fikri Abu-Zidan; Carlos Ordonez; Yunfeng Cui; Francesco Labricciosa; Gennaro Perrone; Francesco Di Marzo; Andrew Peitzman; Boris Sakakushev; Michael Sugrue; Marja Boermeester; Ramiro Manzano Nunez; Carlos Augusto Gomes; Miklosh Bala; Yoram Kluger; Fausto Catena Journal: World J Emerg Surg Date: 2021-08-09 Impact factor: 5.469