Key result
Preoperative leukopenia before emergent laparotomy is linked to ~126% greater mortality versus normal WBC counts.
Why the study?
Does preoperative leukopenia increase mortality and major morbidity in patients undergoing emergent laparotomy?
Cohort (n=20,443)
Yes
Does preoperative leukopenia increase mortality and major morbidity in patients undergoing emergent laparotomy?
Absolute Event Rate: 24.4% vs 10.8%
p-value: p=<0.001
Preoperative leukopenia is a significant predictor of mortality and major morbidity in patients undergoing emergent laparotomy, though it is not necessarily prohibitive.
Preoperative leukopenia may flag higher-risk emergent laparotomy patients; hypothesis-generating for risk models and needs prospective validation.
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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Gulack et al. (2015) conducted a cohort in Emergent laparotomy (n=20,443). Leukopenia (preoperative WBC < 4.0 × 10^9/L) vs. Normal preoperative WBC count (4.0-12.0 × 10^9/L) was evaluated on Mortality (p=<0.001). Preoperative leukopenia in patients undergoing emergent laparotomy was associated with significantly higher mortality compared to a normal white blood cell count (24.4% vs. 10.8%, p < 0.001).
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