Preoperative leukocyte count and postoperative inpatient mortality in South African non-cardiac surgery patients

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Nafisa Abbas
Yoshan Moodley



Background: Published studies investigating the relationship between preoperative leukocyte counts and postoperative inpatient mortality in South African (SA) non-cardiac surgery settings are scarce. This could have important implications for perioperative risk stratification in SA non-cardiac surgery settings. The aim of our study was to address this paucity in the literature.

Methods: We conducted an unmatched case-control study of patient data from the South African Surgical Outcomes Study. Data collected for each patient included demographic variables, comorbidities, procedure-related variables, and preoperative laboratory test results (including leukocyte counts). Local reference ranges were used to stratify preoperative leukocyte count into three categories: normal, leukocytopenia, and leukocytosis. The sample size for this study was 495 patients (case:control ratio of 1:3). Data were analyzed using appropriate univariate and multivariate statistical methods.

Results: Preoperative leukocytosis was associated with increased postoperative inpatient mortality (odds ratio: 1.95, 95% confidence interval: 1.05-3.63; p=0.034). Preoperative leukocytopenia was not associated with postoperative inpatient mortality (odds ratio: 0.40, 95% confidence interval: 0.05-3.40; p=0.400).

Conclusion: Preoperative leukocytosis is a risk factor for postoperative inpatient mortality in SA non-cardiac surgery patients. Studies evaluating the prognostic accuracy of preoperative leukocytosis for postoperative mortality in SA non-cardiac surgery settings are required.