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Immunosuppression in Surgical Patients

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Textbook of Emergency General Surgery

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Abstract

Patients with a compromised immune system are a heterogeneous group, and when in need of surgery, have an enhanced perioperative risk. Diagnosis of complications can be difficult because of disguised clinical manifestations, causing a delay in the start of treatment, eventually leading to increased morbidity and mortality rates. Immunocompetence can be altered by stress responses evoked by the onset of acute illness, a surgical procedure, or postoperative complications. This chapter provides an overview of immunosuppressed patients undergoing surgery divided into six different groups: patients on steroids, after transplantation, with HIV or AIDS, elderly, patients with malnutrition, and with malignancy.

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References

  1. Jabbour SA. Steroids and the surgical patient. Med Clin North Am. 2001;85(5):1311–7.

    Article  CAS  PubMed  Google Scholar 

  2. Axelrod L. Perioperative management of patients treated with glucocorticoids. Endocrinol Metab Clin North Am. 2003;32(2):367–83. https://doi.org/10.1016/S0889-8529(03)00008-2.

    Article  CAS  PubMed  Google Scholar 

  3. Bornstein SR, Allolio B, Arlt W, Barthel A, Don-Wauchope A, Hammer GD, Husebye ES, Merke DP, Murad MH, Stratakis CA, Torpy DJ. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2016;101(2):364–89. https://doi.org/10.1210/jc.2015-1710.

    Article  CAS  PubMed  Google Scholar 

  4. Kehlet H, Binder C. Adrenocortical function and clinical course during and. Br J Anaesth. 1973;45(10):1043–8. https://doi.org/10.1093/bja/45.10.1043.

    Article  CAS  PubMed  Google Scholar 

  5. Yong SL, Coulthard P, Wrzosek A. Supplemental perioperative steroids for surgical patients with adrenal insufficiency. Cochrane Database Syst Rev. 2013;2013(10):CD005367. https://doi.org/10.1002/14651858.CD005367.pub4.

    Article  Google Scholar 

  6. Groleau C, Morin SN, Vautour L, Amar-Zifkin A, Bessissow A. Perioperative corticosteroid administration: a systematic review and descriptive analysis. Perioper Med (Lond). 2018;7(1):1–8. https://doi.org/10.1186/s13741-018-0092-9.

    Article  Google Scholar 

  7. Liu M, Reidy A, Saatee S, Collard CD. Perioperative steroid management: approaches based on current evidence. Anesthesiology. 2017;127(1):166–72.

    Article  PubMed  Google Scholar 

  8. Shapiro R, Young JB, Milford EL, Trotter JF, Bustami RT, Leichtman AB. Immunosuppression: evolution in practice and trends, 1993–2003. Am J Transplant. 2005;5(4 Pt 2):874–86. https://doi.org/10.1111/j.1600-6135.2005.00833.x.

    Article  PubMed  Google Scholar 

  9. de’Angelis N, Esposito F, Memeo R, Lizzi V, Martìnez-Pérez A, Landi F, Genova P, Catena F, Brunetti F, Azoulay D. Emergency abdominal surgery after solid organ transplantation: a systematic review. World J Emerg Surg. 2016;11(1):1–12. https://doi.org/10.1186/s13017-016-0101-6.

    Article  Google Scholar 

  10. Maurer JR. The spectrum of colonic complications in a lung transplant population. Ann Transplant. 2000;5(3):54–7. http://www.ncbi.nlm.nih.gov/pubmed/11147030.

    CAS  PubMed  Google Scholar 

  11. Kang JY, Hoare J, Tinto A, Subramanian S, Ellis C, Majeed A, Melville D, Maxwell JD. Diverticular disease of the colon—on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther. 2003;17(9):1189–95. https://doi.org/10.1046/j.1365-2036.2003.01551.x.

    Article  CAS  PubMed  Google Scholar 

  12. Hjern F, Johansson C, Mellgren A, Baxter NN, Hjern A. Diverticular disease and migration—the influence of acculturation to a Western lifestyle on diverticular disease. Aliment Pharmacol Ther. 2006;23(6):797–805. https://doi.org/10.1111/j.1365-2036.2006.02805.x.

    Article  CAS  PubMed  Google Scholar 

  13. Oor JE, Atema JJ, Boermeester MA, Vrouenraets BC, Ünlü Ç. A systematic review of complicated diverticulitis in post-transplant patients. J Gastrointest Surg. 2014;18(11):2038–46. https://doi.org/10.1007/s11605-014-2593-2.

    Article  CAS  PubMed  Google Scholar 

  14. Bender BS, Bender JS. Surgical issues in the management of the HIV-infected patient. Surg Clin North Am. 1993;73(2):373–88. https://doi.org/10.1016/s0039-6109(16)45988-8.

    Article  CAS  PubMed  Google Scholar 

  15. World Health Organization. World Health Organization. Interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definitions for surveillance: African region. World Health Organization. 2005. https://doi.org/10.1097/01.nme.0000430823.37826.35.

  16. Trickey A, May MT, Vehreschild JJ, Obel N, Gill MJ, Crane HM, Boesecke C, Patterson S, Grabar S, Cazanave C, Cavassini M, Shepherd L, d’Arminio Monforte A, van Sighem A, Saag M, Lampe F, Hernando V, Montero M, Zangerle R, Justice AC, Sterling T, Ingle SM, Sterne JAC. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017;4(8):e349–56. https://doi.org/10.1016/S2352-3018(17)30066-8.

    Article  Google Scholar 

  17. Kouanfack OSD, Kouanfack C, Billong SC, Cumber SN, Nkfusai CN, Bede F, Wepngong E, Hubert C, Tsague Georges GNK, Singwe MN. Epidemiology of opportunistic infections in HIV infected patients on treatment in accredited HIV treatment centers in Cameroon. Int J MCH AIDS. 2019;8(2):163–72. https://doi.org/10.21106/ijma.302.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Madiba TE, Muckart DJJ, Thomson SR. Human immunodeficiency disease: how should it affect surgical decision making? World J Surg. 2009;33(5):899–909. https://doi.org/10.1007/s00268-009-9969-6.

    Article  CAS  PubMed  Google Scholar 

  19. Watters DA. Surgery for tuberculosis before and after human immunodeficiency virus infection: a tropical perspective. Br J Surg. 1997;84(1):8–14. http://www.ncbi.nlm.nih.gov/pubmed/9043439.

    CAS  PubMed  Google Scholar 

  20. World Health Organization. Global tuberculosis report 2020; 2020.

    Google Scholar 

  21. Ross M, Klotman P, Winston J. HIV-associated nephropathy: case study and review of the literature. AIDS Patient Care STDs. 2000;14(12):637–45.

    Article  CAS  PubMed  Google Scholar 

  22. Hernández-Ramírez RU, Shiels MS, Dubrow R, Engels EA. Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. Lancet HIV. 2017;4(11):e495–504. https://doi.org/10.1016/S2352-3018(17)30125-X.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Biggar RJ, Chaturvedi AK, Goedert JJ, Engels EA. AIDS-related cancer and severity of immunosuppression in persons with AIDS. J Natl Cancer Inst. 2007;99(12):962–72. https://doi.org/10.1093/jnci/djm010.

    Article  PubMed  Google Scholar 

  24. Mocroft A, Furrer HJ, Miro JM, Reiss P, Mussini C, Kirk O, Abgrall S, Ayayi S, Bartmeyer B, Braun D, Castagna A, D’Arminio Monforte A, Gazzard B, Gutierrez F, Hurtado I, Jansen K, Meyer L, Muñoz P, Obel N, Soler-Palacin P, Papadopoulos A, Raffi F, Ramos JT, Rockstroh JK, Salmon D, Torti C, Warszawski J, De Wit S, Zangerle R, Fabre-Colin C, Kjaer J, Chene G, Grarup J, Lundgren JD. The incidence of AIDS-defining illnesses at a current CD4 count ≥200 cells/μL in the post-combination antiretroviral therapy era. Clin Infect Dis. 2013;57(7):1038–47. https://doi.org/10.1093/cid/cit423.

    Article  CAS  PubMed  Google Scholar 

  25. Owotade F, Ogunbodede E, Sowande O. HIV/AIDS pandemic and surgical practice in a Nigerian teaching hospital. Trop Doct. 2003;33:228–31. https://doi.org/10.1258/0049475054036832.

    Article  PubMed  Google Scholar 

  26. Sandler BJ, Davis KA, Schuster KM. Symptomatic human immunodeficiency virus-infected patients have poorer outcomes following emergency general surgery: a study of the nationwide inpatient sample. J Trauma Acute Care Surg. 2019;86(3):479–88. https://doi.org/10.1097/TA.0000000000002161.

    Article  PubMed  Google Scholar 

  27. Chichom-Mefire A, Azabji-Kenfack M, Atashili J. CD4 count is still a valid indicator of outcome in HIV-infected patients undergoing major abdominal surgery in the era of highly active antiretroviral therapy. World J Surg. 2015;39(7):1692–9. https://doi.org/10.1007/s00268-015-2994-8.

    Article  CAS  PubMed  Google Scholar 

  28. Deneve JL, Shantha JG, Page AJ, Wyrzykowski AD, Rozycki GS, Feliciano DV. CD4 count is predictive of outcome in HIV-positive patients undergoing abdominal operations. Am J Surg. 2010;200(6):694–700. https://doi.org/10.1016/j.amjsurg.2010.07.030.

    Article  PubMed  Google Scholar 

  29. Yang J, Wei G, He Y, Hua X, Feng S, Zhao Y, Chen T, Wang H, Guo L. Perioperative antiretroviral regimen for HIV/AIDS patients who underwent abdominal surgery. World J Surg. 2020;44(6):1790–7. https://doi.org/10.1007/s00268-020-05402-8.

    Article  PubMed  Google Scholar 

  30. Harris HW, Schecter WP. Surgical risk assessment and management in patients with HIV disease. Gastroenterol Clin North Am. 1997;26(2):377–91. https://doi.org/10.1016/S0889-8553(05)70300-9.

    Article  CAS  PubMed  Google Scholar 

  31. Castelo-Branco C, Soveral I. The immune system and aging: a review. Gynecol Endocrinol. 2014;30(1):16–22. https://doi.org/10.3109/09513590.2013.852531.

    Article  CAS  PubMed  Google Scholar 

  32. Jiang L, Zheng Z, Zhang M. The incidence of geriatric trauma is increasing and comparison of different scoring tools for the prediction of in-hospital mortality in geriatric trauma patients. World J Emerg Surg. 2020;15(1):1–8. https://doi.org/10.1186/s13017-020-00340-1.

    Article  Google Scholar 

  33. Arenal JJ, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg. 2003;46(2):111–6. http://www.ncbi.nlm.nih.gov/pubmed/12691347.

    PubMed  PubMed Central  Google Scholar 

  34. Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. https://doi.org/10.1186/s12877-016-0329-8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):146–57. https://doi.org/10.1093/gerona/56.3.m146.

    Article  Google Scholar 

  36. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95. https://doi.org/10.1503/cmaj.050051.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mariconda M, Costa GG, Cerbasi S, Recano P, Aitanti E, Gambacorta M, Misasi M. The determinants of mortality and morbidity during the year following fracture of the hip: a prospective study. Bone Joint J. 2015;97-B(3):383–90. https://doi.org/10.1302/0301-620X.97B3.34504.

    Article  CAS  PubMed  Google Scholar 

  38. Lee TC, Ho PS, Lin HT, Ho ML, Huang HT, Chang JK. One-year readmission risk and mortality after hip fracture surgery: a national population-based study in Taiwan. Aging Dis. 2017;8(4):402–9. https://doi.org/10.14336/AD.2016.1228.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Civinini R, Paoli T, Cianferotti L, Cartei A, Boccaccini A, Peris A, Brandi ML, Rostagno C, Innocenti M. Functional outcomes and mortality in geriatric and fragility hip fractures—results of an integrated, multidisciplinary model experienced by the “Florence hip fracture unit”. Int Orthop. 2019;43(1):187–92. https://doi.org/10.1007/s00264-018-4132-3.

    Article  PubMed  Google Scholar 

  40. Panula J, Pihlajamäki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P, Kivelä SL. Mortality and cause of death in hip fracture patients aged 65 or older—A population-based study. BMC Musculoskelet Disord. 2011;12:2–7. https://doi.org/10.1186/1471-2474-12-105.

    Article  Google Scholar 

  41. Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing. 2014;43(4):464–71. https://doi.org/10.1093/ageing/afu065.

    Article  PubMed  Google Scholar 

  42. Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, Germagnoli L, Liberati A, Banfi G. Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One. 2012;7(10):e46175. https://doi.org/10.1371/journal.pone.0046175.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ. Variations in mortality after emergency laparotomy: the first report of the UK emergency laparotomy network. Br J Anaesth. 2012;109(3):368–75. https://doi.org/10.1093/bja/aes165.

    Article  CAS  Google Scholar 

  44. Omari AH, Khammash MR, Qasaimeh GR, Shammari AK, Yaseen MKB, Hammori SK. Acute appendicitis in the elderly: risk factors for perforation. World J Emerg Surg. 2014;9(1):1–6. https://doi.org/10.1186/1749-7922-9-6.

    Article  Google Scholar 

  45. Loozen CS, Van Santvoort HC, Van Duijvendijk P, Besselink MG, Gouma DJ, Nieuwenhuijzen GA, Kelder JC, Donkervoort SC, Van Geloven AA, Kruyt PM, Roos D, Kortram K, Kornmann VN, Pronk A, Van Der Peet DL, Crolla RM, Van Ramshorst B, Bollen TL, Boerma D. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ. 2018;363:k3965. https://doi.org/10.1136/bmj.k3965.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50. https://doi.org/10.1016/j.clnu.2017.02.013.

    Article  PubMed  Google Scholar 

  47. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21. https://doi.org/10.1016/S0261-5614(03)00098-0.

    Article  CAS  PubMed  Google Scholar 

  48. Kruizenga H, Van Keeken S, Weijs P, Bastiaanse L, Beijer S, Huisman-De Waal G, Jager-Wittenaar H, Jonkers-Schuitema C, Klos M, Remijnse-Meester W, Witteman B, Thijs A. Undernutrition screening survey in 564,063 patients: patients with a positive undernutrition screening score stay in hospital 1.4 d longer. Am J Clin Nutr. 2016;103(4):1026–32. https://doi.org/10.3945/ajcn.115.126615.

    Article  CAS  PubMed  Google Scholar 

  49. Felder S, Braun N, Stanga Z, Kulkarni P, Faessler L, Kutz A, Steiner D, Laukemann S, Haubitz S, Huber A, Mueller B, Schuetz P. Unraveling the link between malnutrition and adverse clinical outcomes: Association of Acute and Chronic Malnutrition Measures with blood biomarkers from different pathophysiological states. Ann Nutr Metab. 2016;68(3):164–72. https://doi.org/10.1159/000444096.

    Article  CAS  PubMed  Google Scholar 

  50. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krähenbühl L, Meier R, Liberda M. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr. 2008;27(3):340–9. https://doi.org/10.1016/j.clnu.2008.03.012.

    Article  PubMed  Google Scholar 

  51. Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31(3):345–50. https://doi.org/10.1016/j.clnu.2011.11.001.

    Article  PubMed  Google Scholar 

  52. Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, Reznor G, Salim A. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015;78(2):306–11. https://doi.org/10.1097/TA.0000000000000517.

    Article  PubMed  Google Scholar 

  53. Jia Z, El Moheb M, Nordestgaard A, Lee JM, Meier K, Kongkaewpaisan N, Han K, El Hechi MW, Mendoza A, King D, Fagenholz P, Saillant N, Rosenthal M, Velmahos G, Kaafarani HMA. The geriatric nutritional risk index is a powerful predictor of adverse outcome in the elderly emergency surgery patient. J Trauma Acute Care Surg. 2020;89(2):397–404. https://doi.org/10.1097/TA.0000000000002741.

    Article  CAS  PubMed  Google Scholar 

  54. Bouillanne O, Morineau G, Dupant C, Coulombel I, Vincent JP, Nicolis I, Benazeth S, Cynober L, Aussel C. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777–83. https://doi.org/10.1093/ajcn/82.4.777.

    Article  CAS  PubMed  Google Scholar 

  55. Garth AK, Newsome CM, Simmance N, Crowe TC. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet. 2010;23(4):393–401. https://doi.org/10.1111/j.1365-277X.2010.01058.x.

    Article  CAS  PubMed  Google Scholar 

  56. Gillis C, Carli F. Promoting perioperative metabolic and nutritional care. Anesthesiology. 2015;123(6):1455–72. https://doi.org/10.1097/ALN.0000000000000795.

    Article  CAS  PubMed  Google Scholar 

  57. Zhuang CL, Ye XZ, Zhang XD, Chen BC, Yu Z. Enhanced recovery after surgery programs versus traditional care for colorectal surgery: a metaanalysis of randomized controlled trials. Dis Colon Rectum. 2013;56(5):667–78. https://doi.org/10.1097/DCR.0b013e3182812842.

    Article  PubMed  Google Scholar 

  58. Lohsiriwat V, Jitmungngan R. Enhanced recovery after surgery in emergency colorectal surgery: review of literature and current practices. World J Gastrointest Surg. 2019;11(2):41–52. https://doi.org/10.4240/wjgs.v11.i2.41.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Muscaritoli M, Lucia S, Farcomeni A, Lorusso V, Saracino V, Barone C, Plastino F, Gori S, Magarotto R, Carteni G, Chiurazzi B, Pavese I, Marchetti L, Zagonel V, Bergo E, Tonini G, Imperatori M, Iacono C, Maiorana L, Pinto C, Rubino D, Cavanna L, Di Cicilia R, Gamucci T, Quadrini S, Palazzo S, Minardi S, Merlano M, Colucci G, Marchetti P, Fioretto L, Cipriani G, Barni S, Lonati V, Frassoldati A, Surace GC, Porzio G, Martella F, Altavilla G, Santarpia MC, Pronzato P, Levaggi A, Contu A, Contu M, Adamo V, Berenato R, Marchetti F, Pellegrino A, Violante S, Guida M. Prevalence of malnutrition in patients at first medical oncology visit: the PreMiO study. Oncotarget. 2017;8(45):79884–96. https://doi.org/10.18632/oncotarget.20168.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Yucel N, Sukru Erkal H, Sinem Akgun F, Serin M. Characteristics of the admissions of cancer patients to emergency department. J BUON. 2012;17(1):174–9. http://www.ncbi.nlm.nih.gov/pubmed/22517714.

    CAS  PubMed  Google Scholar 

  61. Bosscher MRF, Van Leeuwen BL, Hoekstra HJ. Current management of surgical oncologic emergencies. PLoS One. 2015;10(5):1–12. https://doi.org/10.1371/journal.pone.0124641.

    Article  CAS  Google Scholar 

  62. Spannenburg L, Sanchez Gonzalez M, Brooks A, Wei S, Li X, Liang X, Gao W, Wang H. Surgical outcomes of colonic stents as a bridge to surgery versus emergency surgery for malignant colorectal obstruction: a systematic review and meta-analysis of high quality prospective and randomised controlled trials. Eur J Surg Oncol. 2020;46(8):1404–14. https://doi.org/10.1016/j.ejso.2020.04.052.

    Article  PubMed  Google Scholar 

  63. Snydman DR, Nesher L, Rolston KVI. Neutropenic enterocolitis, a growing concern in the era of widespread use of aggressive chemotherapy. Clin Infect Dis. 2013;56(5):711–7. https://doi.org/10.1093/cid/cis998.

    Article  Google Scholar 

  64. Gorschlüter M, Mey U, Strehl J, Ziske C, Schepke M, Schmidt-Wolf IGH, Sauerbruch T, Glasmacher A. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol. 2005;75(1):1–13. https://doi.org/10.1111/j.1600-0609.2005.00442.x.

    Article  PubMed  Google Scholar 

  65. Clarenbach R, Ho K, Gorschlu M, Baumgartner S, Hahn C, Ziske C, Mey U, Heller R, Sauerbruch T, Schmidt-Wolf IGH, Eis-Hübinger AM. Abdominal infections in patients with acute leukaemia: a prospective study applying ultrasonography and microbiology. Br J Haematol. 2002;117:351–8.

    Article  PubMed  Google Scholar 

  66. Cartoni C, Dragoni F, Micozzi A, Pescarmona E, Mecarocci S, Chirletti P, Petti MC, Meloni G, Mandelli F. Neutropenic enterocolitis in patients with acute leukemia: prognostic significance of bowel wall thickening detected by ultrasonography. J Clin Oncol. 2001;19(3):756–61. https://doi.org/10.1200/JCO.2001.19.3.756.

    Article  CAS  PubMed  Google Scholar 

  67. Davila ML. Neutropenic enterocolitis (Typhlitis). Imaging Gastroenterol 2018:256–257. https://doi.org/10.1016/b978-0-323-55408-4.50127-0.

  68. Rodrigues FG, Dasilva G, Wexner SD. Neutropenic enterocolitis. World J Gastroenterol. 2017;23(1):42–7. https://doi.org/10.3748/wjg.v23.i1.42.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Kim KU, Kim JK, Won JH, Hong DS, Park HS. Acute appendicitis in patients with acute leukemia. Korean J Intern Med. 1993;8(1):40–5. https://doi.org/10.3904/kjim.1993.8.1.40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Forghieri F, Luppi M, Narni F, Morselli M, Potenza L, Bresciani P, Volzone F, Rossi G, Rossi A, Trenti L, Barozzi P, Torelli G. Acute appendicitis in adult neutropenic patients with hematologic malignancies. Bone Marrow Transplant. 2008;42(10):701–3. https://doi.org/10.1038/bmt.2008.235.

    Article  CAS  PubMed  Google Scholar 

  71. Kogut MJ, Bastawrous S, Padia S, Bhargava P. Hepatobiliary oncologic emergencies: imaging appearances and therapeutic options. Curr Probl Diagn Radiol. 2013;42(3):113–26. https://doi.org/10.1067/j.cpradiol.2012.08.003.

    Article  PubMed  Google Scholar 

  72. Sullivan MC, Roman SA, Sosa JA. Does chemotherapy prior to emergency surgery affect patient outcomes? Examination of 1912 patients. Ann Surg Oncol. 2012;19(1):11–8. https://doi.org/10.1245/s10434-011-1844-7.

    Article  PubMed  Google Scholar 

  73. Koretz MJ, Neifeld JP. Emergency surgical treatment for patients with acute leukemia. Surg Gynecol Obstet. 1985;161(2):149–51. http://www.ncbi.nlm.nih.gov/pubmed/3860992.

    CAS  PubMed  Google Scholar 

  74. Fahy BN, Aloia TA, Jones SL, Bass BL, Fischer CP. Chemotherapy within 30 days prior to liver resection does not increase postoperative morbidity or mortality. HPB. 2009;11(8):645–55. https://doi.org/10.1111/j.1477-2574.2009.00107.x.

    Article  PubMed  PubMed Central  Google Scholar 

  75. 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;79(3):437–43. https://doi.org/10.1097/TA.0000000000000757.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands

    Hannah Groenen & Marja A. Boermeester

  2. Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, The Netherlands

    Hannah Groenen

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Correspondence to Marja A. Boermeester .

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Editors and Affiliations

  1. General, Emergency and Trauma Surgery Dept., Pisa University Hospital, Pisa, Italy

    Federico Coccolini

  2. General and Emergency Surgery Dept., Bufalini Hospital, Cesena, Italy

    Fausto Catena

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Groenen, H., Boermeester, M.A. (2023). Immunosuppression in Surgical Patients. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_21

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  • DOI: https://doi.org/10.1007/978-3-031-22599-4_21

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