Leukocytosis after robotic hysterectomy: commonly observed but clinically insignificant

Abstract

Laboratory studies are commonly performed after surgery, but with little evidence of clinical utility. We evaluated our experience with measuring a complete blood count (CBC) to determine peripheral blood leukocyte count (WBC) postoperatively following consecutive robotic hysterectomies. From January 2008 through November 2009, two surgeons (KM, HM) performed 204 robotic hysterectomies. Patient age, weight, height, indication for surgery, surgical procedure, operative time, estimated blood loss, hospital length of stay, postoperative fever, and complications were prospectively recorded and correlated with WBC measured on the day after surgery. The postoperative WBC was elevated (>11,000/μl) in 59/204 (29%) patients. Eight (4%) patients had marked leukocytosis (WBC >15,000/μl; maximum 16,600/μl). There was no correlation between postoperative leukocytosis and operative time, BMI, performance of lymphadenectomy, or length of hospitalization. The only factor significantly associated with elevated postoperative WBC was elevated preoperative WBC (P < .001). Also, there was no correlation between postoperative leukocytosis with fever or infectious complications. The mean T max was 37.1ºC and T max over 38ºC was seen in nine patients. Of the five women who developed infectious complications, only one (diagnosed with pneumonia) had a minimally elevated postoperative WBC (11,600/μl); the other four (pneumonia and pelvic abscess, two each) had normal postoperative WBC. Routine measurement of WBC after robotic hysterectomy is not useful. In about 25% of cases there will be a slight leukocytosis, and rarely (about 4%) will the WBC exceed 15,000/μl. In no case was measurement of postoperative WBC clinically relevant.

Intraoperative ureter visualization using a near-infrared imaging agent

“…Similarly, observed changes in laboratory parameters Table S1 in the Supplementary Materials are consistent with what is reasonably expected after hysterectomy surgery. The increased WBC 19,20 and decrease in RBC, HCT and HgB, 21 serum albumin, 22 and serum calcium 23 is consistent with observed changes following routine surgery and shows no dose-dependent increase in mean change from baseline, suggesting this effect was not drug related. The mean change from baseline normalized over time to the 14-day follow-up time-point.…”

“…An increased WBC is consistent with the hysterectomy surgery and recovery. 19,20 There was no dose-dependent increase in mean change from baseline for WBC, suggesting this effect was not drug related. Mean change from baseline normalized over time to the 14-day recovery.…”

The Etiology and Prognosis of Delayed Postoperative Leukocytosis in Lung Transplant Recipients

“…Postoperative leukocytosis is common; reported prevalence is 29%, 38%, and 92% after gynecologic, 6 orthopedic, 5 and lung transplant 17 surgeries, respectively. Consistent with prior studies, early postoperative leukocytosis was seen in this study in almost all lung transplant recipients.…”

“…1 The normal physiological response of bone marrow to infection and inflammation yields an increase in WBCs, predominantly polymorphonuclear leukocytes and less mature cell forms, a process referred to as left shift. 2 Noninfectious factors may also trigger an elevation in WBC count, including physical stress due to seizures, 3 anesthesia, 4 or surgical trauma, 5,6 as well as emotional stress 7 and pharmacological stress due to corticosteroids 8 or lithium. 9 Early postoperative leukocytosis, occurring in the first 3 days after lung transplantation, is generally attributable to high-dose steroid administration.…”

Diagnostic and therapeutic value of biomarkers in urosepsis

“…In addition, the surgery itself causes a physiological increase in WBC. Goel et al 32 found that the WBC count increased on the first postoperative day and gradually returned to normal from the fourth day. Other studies have found that symptoms of fever and leukocytosis are more common in infected patients, but only after the sixth postoperative day.…”