Leukocytosis after distal pancreatectomy and splenectomy as a marker of major complication

Thomas K. Maatman, James R. Butler, Stephen N. Quigley, Alexa J. Loncharich, Trevor Crafts, Eugene P. Ceppa, Attila Nakeeb, C. Max Schmidt, Nicholas J. Zyromski, Michael G. House

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study was to analyze the associations between the degree of postoperative leukocytosis and major morbidity after elective distal pancreatectomy with splenectomy (DPS). Methods: Retrospective review of patients undergoing DPS for pancreatic diseases (2013–2016). Receiver operating characteristic curves, Youden's index, and area under the curve were used to identify ideal lab cut-off values and discriminatory ability of postoperative white blood cell count to detect complications. Results: 158 patients underwent DPS. Median age was 57 years (range, 22–90) and 53% of patients were male. POD3 absolute WBC count ≥16 × 109/L or an increase in WBC count ≥9 × 109/L from preoperative baseline was associated with major morbidity after DPS (AUC 0.7 and 0.7, respectively). Conclusion: Postoperative day three leukocytosis ≥16 × 109/L or an increase in WBC of ≥9 × 109/L from preoperative baseline should raise clinical awareness for major postoperative complication after DPS.

Original languageEnglish (US)
JournalAmerican Journal of Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Pancreatectomy
Leukocytosis
Splenectomy
Area Under Curve
Morbidity
Pancreatic Diseases
Leukocyte Count
ROC Curve

Keywords

  • Leukocytosis
  • Pancreatectomy
  • Pancreatic fistula
  • Splenectomy
  • Surgical wound infection

ASJC Scopus subject areas

  • Surgery

Cite this

Leukocytosis after distal pancreatectomy and splenectomy as a marker of major complication. / Maatman, Thomas K.; Butler, James R.; Quigley, Stephen N.; Loncharich, Alexa J.; Crafts, Trevor; Ceppa, Eugene P.; Nakeeb, Attila; Schmidt, C. Max; Zyromski, Nicholas J.; House, Michael G.

In: American Journal of Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Maatman, TK, Butler, JR, Quigley, SN, Loncharich, AJ, Crafts, T, Ceppa, EP, Nakeeb, A, Schmidt, CM, Zyromski, NJ & House, MG 2019, 'Leukocytosis after distal pancreatectomy and splenectomy as a marker of major complication', American Journal of Surgery. https://doi.org/10.1016/j.amjsurg.2019.12.004
Maatman, Thomas K. ; Butler, James R. ; Quigley, Stephen N. ; Loncharich, Alexa J. ; Crafts, Trevor ; Ceppa, Eugene P. ; Nakeeb, Attila ; Schmidt, C. Max ; Zyromski, Nicholas J. ; House, Michael G. / Leukocytosis after distal pancreatectomy and splenectomy as a marker of major complication. In: American Journal of Surgery. 2019.
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AU - Crafts, Trevor

AU - Ceppa, Eugene P.

AU - Nakeeb, Attila

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AU - Zyromski, Nicholas J.

AU - House, Michael G.

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AB - Background: The aim of this study was to analyze the associations between the degree of postoperative leukocytosis and major morbidity after elective distal pancreatectomy with splenectomy (DPS). Methods: Retrospective review of patients undergoing DPS for pancreatic diseases (2013–2016). Receiver operating characteristic curves, Youden's index, and area under the curve were used to identify ideal lab cut-off values and discriminatory ability of postoperative white blood cell count to detect complications. Results: 158 patients underwent DPS. Median age was 57 years (range, 22–90) and 53% of patients were male. POD3 absolute WBC count ≥16 × 109/L or an increase in WBC count ≥9 × 109/L from preoperative baseline was associated with major morbidity after DPS (AUC 0.7 and 0.7, respectively). Conclusion: Postoperative day three leukocytosis ≥16 × 109/L or an increase in WBC of ≥9 × 109/L from preoperative baseline should raise clinical awareness for major postoperative complication after DPS.

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