Outcomes of Abdominal Surgery in Neutropenic Patients
Riad H. Al Natour*, Stanley W. Ashley, Ali Tavakkolizadeh
Surgery, Brigham and Women's Hospital, Boston, MA
Introduction: Surgery in neutropenic patients is thought to be associated with significant morbidity and mortality. No studies to date have quantified these risks. We set out to assess the outcome of abdominal procedures in this patient population and to identify prognostic indicators that will help in the management of these complex cases.Methods: Using an electronic patient database, over 2,000 patients with a diagnosis of neutropenia who had undergone surgery between 1996-2008 were identified. All patient records were reviewed and those with an Absolute Neutrophils Count (ANC) of <1500/mm3 within 24-hours of an abdominal operation were selected. Urologenital procedures and transplants were excluded. Thirty-days-postoperative outcomes were compared based on the severity of neutropenia. National Cancer Institute grading for ANC was considered (Group 1: ANC <500 vs. Group 2: ANC ≥500 and <1000 vs. Group 3: ANC ≥1000 and <1500). Comparisons were made using 3-way Fishers Exact Test.Results: 80 patients with mean age of 53 fulfilled the inclusion criteria (Table). Group 1 patients, with an ANC <500, had a significantly higher post-operative infection rates, and hospital stay, compared to other groups (P<0.01). This group also had a higher mortality rate compared to other groups (p=0.05). In those with ANC <500 at time of surgery, post-operative use of granulocyte colony-stimulating factor (GCSF) had no impact on outcomes.Conclusions: Our data shows that an ANC <500 is associated with significantly higher complication rates, that is not altered by post-operative administration of GCSF. We therefore recommend that surgical intervention in severely neutropenic patients is delayed, when possible, until ANC approaches 500/mm3. Pre-operative administration of GCSF should be considered in these cases to expedite reaching this threshold.
Morbidity and Mortality of neutropenic patients, based on ANC
| Group | Number of patients | Morbidity rate | Mortality rate | Length of Stay (days) |
| 1 (ANC <500) | 19 | 74% | 21% | 12 |
| 2 (ANC 500-<1000) | 17 | 29% | 12% | 10 |
| 3 (ANC 1000-<1500) | 44 | 27% | 2% | 7 |
| OVERALL | 80 | 38% | 9% | 9 |
Back to Program
