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Timing and Outcomes of Abdominal Surgery in Neutropenic Patients

  • 2018 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, CA-034, Boston, MA, 02115, USA

    Joshua S. Jolissaint, Lily V. Saadat, Arin L. Madenci, Bryan V. Dieffenbach & Ali Tavakkoli

  2. Harvard Medical School, Boston, MA, USA

    Maya Harary & Ali Tavakkoli

  3. St. Joseph Mercy Health System, Ann Arbor, MI, USA

    Riad H. Al Natour

  4. Laboratory for Surgical and Metabolic Research, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Ali Tavakkoli

Authors
  1. Joshua S. Jolissaint
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  2. Maya Harary
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  3. Lily V. Saadat
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  4. Arin L. Madenci
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  5. Bryan V. Dieffenbach
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  6. Riad H. Al Natour
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  7. Ali Tavakkoli
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Contributions

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

Corresponding author

Correspondence to Joshua S. Jolissaint.

Ethics declarations

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

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This paper was presented as a Plenary Paper at The Society for Surgery of the Alimentary Tract (SSAT) Annual Meeting, June 5, 2018

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Jolissaint, J.S., Harary, M., Saadat, L.V. et al. Timing and Outcomes of Abdominal Surgery in Neutropenic Patients. J Gastrointest Surg 23, 643–650 (2019). https://doi.org/10.1007/s11605-018-04081-0

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  • DOI: https://doi.org/10.1007/s11605-018-04081-0

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