Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients

Abstract

BackgroundDespite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC) count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients.MethodsCardiac surgeries were extracted from the 2007–2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality.ResultsOut of a total of 10,979 cardiac surgery patients 863 (7.8%) had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09–1.36, p = 0.002) with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications.ConclusionPreoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.

Predictors and Outcomes of Cardiac Events following Thoracic Endovascular Aortic Repair in Descending Thoracic Aortic Aneurysm and Dissection

“…Lastly, it is worthwhile to note that the benefits of preoperative laboratory assessments in the patients undergoing surgery have been discussed. 39,40 In the present study leukocytosis was observed as an independent predictor of CEs after TEVAR. Preoperative leukocytosis may reflect an inflammatory response that might be associated with vascular injury and organ dysfunction, 39,40 increasing the likelihood of CEs.…”

A preoperative nomogram for sepsis in percutaneous nephrolithotomy treating solitary, unilateral and proximal ureteral stones

“…Another systemic factor noted in our study to be closely related to sepsis after PCNL is preoperative leukocytosis (OR = 3.706, P = 0.006). Mahmood et al (2017) reported that preoperative leukocytosis is associated with adverse postoperative outcomes after cardiac surgery and is an independent predictor of infection-related postoperative complications. Sen et al (2016) found that the preoperative neutrophil-lymphocyte ratio may be a promising additive predictor of bacteremia and postoperative sepsis in patients who undergo PCNL for renal stones.…”

Common Sources of Pre-, Peri- and Post Surgical Site Infections (SSI) in Dogs during Clinical Students’ Surgical Practice

“…The marked leukocytosis recorded in the orchidectomy, cystotomy and ovariohysterectomy is a probable indication of systemic inflammatory response (SIR) initiated when barriers to tissues are invaded. Mahmood et al, [15] reported similar marked leukocytosis post operatively which is a marker associated with adverse postoperative outcome. In the present study, the leukocytosis with attendant neutrophillia two days post surgery for caudectomy and orchidectomy surgical groups, as well as four days post surgery for cystotomy and skin defects surgical groups may be an independent predictor of infection-related postoperative complication.…”

“…Fifteen (15) apparently healthy local dogs (males and females) of mean ages 12  0.3 months were purchased by combined team of the Department of Surgery and Radiology, Faculty of Veterinary Medicine; Usmanu Danfodiyo University Sokoto and clinical project students for students' wet lab procedures and graduating students research project. The surgical procedures performed on them were correction of skin defects, cystotomy, caudectomy, orchidectomy and ovariohysterectomy, representing commonest surgical cases handled in the clinic in all case loads.…”