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Leukopenia is associated with worse but not prohibitive outcomes following emergent abdominal surgery.

Publication ,  Journal Article
Gulack, BC; Englum, BR; Lo, DD; Nussbaum, DP; Keenan, JE; Scarborough, JE; Shapiro, ML
Published in: J Trauma Acute Care Surg
September 2015

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.

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Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

September 2015

Volume

79

Issue

3

Start / End Page

437 / 443

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Quality Improvement
  • Prognosis
  • Patient Selection
  • Middle Aged
  • Male
  • Leukopenia
  • Laparotomy
  • Humans
 

Citation

APA
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Gulack, B. C., Englum, B. R., Lo, D. D., Nussbaum, D. P., Keenan, J. E., Scarborough, J. E., & Shapiro, M. L. (2015). Leukopenia is associated with worse but not prohibitive outcomes following emergent abdominal surgery. J Trauma Acute Care Surg, 79(3), 437–443. https://doi.org/10.1097/TA.0000000000000757
Gulack, Brian C., Brian R. Englum, David D. Lo, Daniel P. Nussbaum, Jeffrey E. Keenan, John E. Scarborough, and Mark L. Shapiro. “Leukopenia is associated with worse but not prohibitive outcomes following emergent abdominal surgery.J Trauma Acute Care Surg 79, no. 3 (September 2015): 437–43. https://doi.org/10.1097/TA.0000000000000757.
Gulack BC, Englum BR, Lo DD, Nussbaum DP, Keenan JE, Scarborough JE, et al. Leukopenia is associated with worse but not prohibitive outcomes following emergent abdominal surgery. J Trauma Acute Care Surg. 2015 Sep;79(3):437–43.
Gulack, Brian C., et al. “Leukopenia is associated with worse but not prohibitive outcomes following emergent abdominal surgery.J Trauma Acute Care Surg, vol. 79, no. 3, Sept. 2015, pp. 437–43. Pubmed, doi:10.1097/TA.0000000000000757.
Gulack BC, Englum BR, Lo DD, Nussbaum DP, Keenan JE, Scarborough JE, Shapiro ML. Leukopenia is associated with worse but not prohibitive outcomes following emergent abdominal surgery. J Trauma Acute Care Surg. 2015 Sep;79(3):437–443.

Published In

J Trauma Acute Care Surg

DOI

EISSN

2163-0763

Publication Date

September 2015

Volume

79

Issue

3

Start / End Page

437 / 443

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Quality Improvement
  • Prognosis
  • Patient Selection
  • Middle Aged
  • Male
  • Leukopenia
  • Laparotomy
  • Humans