30-day mortality vs. white blood cell count.

<p>Stepwise plot of 30-day mortality rate against white blood cell count for the sample of 10,979 cardiac surgery patients, illustrating a positive relationship between the two variables.</p

Wound complications vs. white blood cell count.

<p>Stepwise plot of wound complications rate against white blood cell count for the sample of 10,979 cardiac surgery patients, illustrating a positive relationship between the two variables.</p

Final multiple logistic regression model summaries.

<p>Final multiple logistic regression model summaries.</p

Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients

<div><p>Background</p><p>Despite 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.</p><p>Methods</p><p>Cardiac 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.</p><p>Results</p><p>Out 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.</p><p>Conclusion</p><p>Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.</p></div

Medical complications vs. white blood cell count.

<p>Stepwise plot of medical complications rate against white blood cell count for the sample of 10,979 cardiac surgery patients, illustrating a positive relationship between the two variables.</p

Univariate associations between leukocytosis and baseline characteristics.

<p>Univariate associations between leukocytosis and baseline characteristics.</p

Patient Characteristics at Presentation.

<p>Patient Characteristics at Presentation.</p

Hospital characteristics.

<p>Hospital characteristics.</p

Multivariate Model Adjusting for demographics and severity of illness.

<p>Multivariate Model Adjusting for demographics and severity of illness.</p