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Timing and Outcomes of Abdominal Surgery in Neutropenic Patients

  • Joshua S. JolissaintEmail author
  • Maya Harary
  • Lily V. Saadat
  • Arin L. Madenci
  • Bryan V. Dieffenbach
  • Riad H. Al Natour
  • Ali Tavakkoli
2018 SSAT Plenary Presentation
  • 58 Downloads

Abstract

Background

Surgery in neutropenic patients is challenging due to both atypical manifestations of common conditions and higher perioperative risk. We sought to describe the outcomes of neutropenic patients undergoing abdominal surgery and to identify factors contributing to morbidity and mortality.

Methods

A retrospective chart review was performed for all patients neutropenic in the 24-hours prior to an abdominal operation at our institution between 1998 and 2017. The primary and secondary outcomes were 30-day mortality and morbidity, respectively. The chi-square test and two-tailed Student’s t test were used for univariable comparisons (non-parametric tests used when appropriate). To determine the optimal threshold of absolute neutrophil count (ANC) to discriminate 30-day mortality, we maximized the Youden index (J).

Results

Amongst 237 patients, mortality was 11.8% (28/237) and morbidity 54.5% (130/237). Absolute neutrophil count < 500 cells/μL (50% vs. 20.6%, P < 0.01) and perforated viscus (35.7% vs. 14.8%, P = 0.01) were associated with mortality. Perforated viscus (25.4% vs. 7.5%) was also associated with morbidity. Urgent operations were associated with higher morbidity (63.6% vs 34.7%, P < 0.001) and mortality (16.4% vs 1.4%, P = 0.002) when compared to elective operations. Transfer from an outside hospital (22.3% vs. 11.2%, P = 0.02) and longer median time from admission to operation (2 days (IQR 0–6) vs. 1 day (IQR 0–3), P < 0.01) were associated with morbidity. An ANC threshold of 350 provided the best discrimination for mortality.

Conclusions

Elective surgery in the appropriately chosen neutropenic patient is relatively safe. For patients with obvious surgical pathology, we advocate for earlier operation and a lower threshold for surgical consultation in an effort expedite the diagnosis and necessary treatment.

Keywords

General surgery Neutropenia Outcomes research 

Notes

Author Contribution

All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship.

Compliance with Ethical Standards

This study was approved by the Partners Healthcare Institutional Review Board (Protocol 2006P001280) and informed consent was waived.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  1. 1.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.St. Joseph Mercy Health SystemAnn ArborUSA
  4. 4.Laboratory for Surgical and Metabolic Research, Department of SurgeryBrigham and Women’s HospitalBostonUSA

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