Preoperative White Blood Cell Count in Patients with Abdominal Aortic Aneurysms and Its Relation to Survival following Surgery

Berge, Camilla; Hagen, Anne Irene; Myhre, Hans O.; Dahl, Torbjørn

doi:10.1016/j.avsg.2016.08.028

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…In 2011, Bhutta et al reported that a neutrophil‐lymphocyte ratio >5 was independently associated with higher mortality as far as 2 years out from major vascular surgery (AOR 2.21 95% CI, 1.22‐4.01, P = .009). More recently in 2017, Berge et al found that a preoperative WBC count ≥11,000/µL was associated with nearly nine‐fold higher 30‐day mortality rates after repair of an intact abdominal aortic aneurysm. Though the exact mechanism behind the relationship between preoperative WBC count and anastomotic leak is unknown, our finding of an association seems biologically plausible, and congruent with previous reports.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

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Background: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak.Methods: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak.Results: Of 915 patients included, 83% were male and the median age was 64 years.Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak.Conclusion: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.

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Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Hall

Flores

Parshall

et al. 2019

Journal of Surgical Oncology

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“…It has long been established that inflammation plays a huge role in onset and progression of AAA. Elevated C-reactive proteins levels detected in AAA patients [34,35], as well as a large leukocyte presence in the aortic wall of AAA patients [36], provide a strong indication of immune system involvement in AAA, as well as AD [37] and rupture [38,39]. In 1972, Walker et al described the ‘inflammatory aneurysm’ with ‘extensive active chronic inflammatory changes’ seen in tissue sections of aneurysm patients [40] with the inflammatory variant of AAA disease [41].…”

Section: Cellular and Molecular Pathophysiology Of Aaa And Admentioning

confidence: 99%

Matrix Metalloproteinase in Abdominal Aortic Aneurysm and Aortic Dissection

et al. 2019

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Abdominal Aortic Aneurysm (AAA) affects 4–5% of men over 65, and Aortic Dissection (AD) is a life-threatening aortic pathology associated with high morbidity and mortality. Initiators of AAA and AD include smoking and arterial hypertension, whilst key pathophysiological features of AAA and AD include chronic inflammation, hypoxia, and large modifications to the extra cellular matrix (ECM). As it stands, only surgical methods are available for preventing aortic rupture in patients, which often presents difficulties for recovery. No pharmacological treatment is available, as such researchers are attempting to understand the cellular and molecular pathophysiology of AAA and AD. Upregulation of matrix metalloproteinase (MMPs), particularly MMP-2 and MMP-9, has been identified as a key event occurring during aneurysmal growth. As such, several animal models of AAA and AD have been used to investigate the therapeutic potential of suppressing MMP-2 and MMP-9 activity as well as modulating the activity of other MMPs, and TIMPs involved in the pathology. Whilst several studies have offered promising results, targeted delivery of MMP inhibition still needs to be developed in order to avoid surgery in high risk patients.

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“…Preoperative WBC count is a crude estimate of the patient's baseline inflammatory state and has been shown to be predictive of in-hospital complications (e.g., bleeding, mortality) and 30-day readmissions across procedures from several surgical fields. [34][35][36][37][38] We sought to understand the relationship between infection etiology and high WBC count, both of which were identified as independent risk factors for 30-day readmission in our analysis. As noted by Eichinger and Galvin, 39 TSA patients with joint infection rarely present with elevated WBC, C-reactive protein, or erythrocyte sedimentation rate.…”

Section: Risk Factors For Adverse Events and Unplanned Readmissionmentioning

confidence: 99%

Risk factors for and timing of adverse events after revision total shoulder arthroplasty

et al. 2018

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Background Despite increasing rates of revision total shoulder arthroplasty (RTSA), there is a paucity of literature on optimizing perioperative outcomes. The purposes of this study were to identify risk factors for unplanned readmission and perioperative complications following RTSA, risk-stratify patients based on these risk factors, and assess timing of complications. Methods Bivariate and multivariate analyses of risk factors were assessed on RTSA patients from the ACS-NSQIP database from 2011 to 2015. Patients were risk-stratified and timing of severe adverse events and cause of readmission were evaluated. Results Of 809 RTSA patients, 61 suffered a perioperative complication or readmission within 30 days of discharge. Multivariate analysis identified operative time, BMI > 40, infection etiology, high white blood cell count, and low hematocrit as significant independent risk factors for 30-day complications or readmission after RTSA (p ≤ 0.05). Having at least one significant risk factor was associated with 2.71 times risk of complication or readmission within 15 days compared to having no risk factors (p < 0.001). The majority of unplanned readmission, return to the operating room, open/deep wound infection, and sepsis/septic shock occurred within two weeks of RTSA. Discussion Patients at high risk of complications and readmission after RTSA should be identified and optimized preoperatively to improve outcomes and lower costs.

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Preoperative White Blood Cell Count in Patients with Abdominal Aortic Aneurysms and Its Relation to Survival following Surgery

Cited by 8 publications

References 19 publications

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Risk factors for anastomotic leak after esophagectomy for cancer: A NSQIP procedure‐targeted analysis

Matrix Metalloproteinase in Abdominal Aortic Aneurysm and Aortic Dissection

Risk factors for and timing of adverse events after revision total shoulder arthroplasty

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