Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease

Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease. Jones, S. M., McCracken, C., Alsoufi, B., Mahle, W. T., & Oster, M. E. The Annals of Thoracic Surgery, 106(4):1234–1240, 2018.
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BACKGROUND: We examined the association of preoperative cell count abnormalities, which have been shown to be associated with outcomes in adult cardiac patients, with morbidity and mortality after operation for congenital heart disease (CHD) in children. METHODS: We performed a retrospective cohort study on 4,865 children undergoing cardiac operation from 2004 to 2014. Our exposures of interest were presence of preoperative lymphopenia (lymphocyte count ≤ 3,000 cells/μL), thrombocytopenia (platelet count \textless 150 × 103/μL), and neutrophilia (neutrophil count ≥ 7,000 cells/μL). Our outcomes of interest were mortality status, postoperative length of stay (LOS), and occurrence of postoperative complications. We performed logistic and linear regressions to determine the associations of preoperative cell counts with mortality, LOS, and complications, adjusting for age, sex, race or ethnicity, presence of a genetic syndrome, and Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality category. RESULTS: Overall mortality was 2.8%, median LOS was 6 days, and 7.6% of patients had postoperative complications. Lymphopenia was associated with increased odds of postoperative mortality (odds ratio 1.67, 95% confidence interval: 1.15 to 2.43, p = 0.007). Lymphopenia, thrombocytopenia, and neutrophilia were all associated with longer postoperative LOS. Lymphopenia and thrombocytopenia were associated with increased occurrence of postoperative sepsis, and neutrophilia was associated with need for postoperative mechanical circulatory support. CONCLUSIONS: In children undergoing CHD operation, preoperative lymphopenia is associated with increased in-hospital mortality postoperatively. Preoperative lymphopenia, neutrophilia, and thrombocytopenia are associated with longer postoperative LOS and with development of postoperative complications. Preoperative cell counts may serve as important prognostic markers in preoperative planning for patients with CHD.

@article{jones_association_2018,
	title = {Association of {Preoperative} {Cell} {Counts} {With} {Outcomes} {After} {Operation} for {Congenital} {Heart} {Disease}},
	volume = {106},
	issn = {1552-6259},
	doi = {10.1016/j.athoracsur.2018.04.022},
	abstract = {BACKGROUND: We examined the association of preoperative cell count abnormalities, which have been shown to be associated with outcomes in adult cardiac patients, with morbidity and mortality after operation for congenital heart disease (CHD) in children.
METHODS: We performed a retrospective cohort study on 4,865 children undergoing cardiac operation from 2004 to 2014. Our exposures of interest were presence of preoperative lymphopenia (lymphocyte count ≤ 3,000 cells/μL), thrombocytopenia (platelet count {\textless} 150 × 103/μL), and neutrophilia (neutrophil count ≥ 7,000 cells/μL). Our outcomes of interest were mortality status, postoperative length of stay (LOS), and occurrence of postoperative complications. We performed logistic and linear regressions to determine the associations of preoperative cell counts with mortality, LOS, and complications, adjusting for age, sex, race or ethnicity, presence of a genetic syndrome, and Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality category.
RESULTS: Overall mortality was 2.8\%, median LOS was 6 days, and 7.6\% of patients had postoperative complications. Lymphopenia was associated with increased odds of postoperative mortality (odds ratio 1.67, 95\% confidence interval: 1.15 to 2.43, p = 0.007). Lymphopenia, thrombocytopenia, and neutrophilia were all associated with longer postoperative LOS. Lymphopenia and thrombocytopenia were associated with increased occurrence of postoperative sepsis, and neutrophilia was associated with need for postoperative mechanical circulatory support.
CONCLUSIONS: In children undergoing CHD operation, preoperative lymphopenia is associated with increased in-hospital mortality postoperatively. Preoperative lymphopenia, neutrophilia, and thrombocytopenia are associated with longer postoperative LOS and with development of postoperative complications. Preoperative cell counts may serve as important prognostic markers in preoperative planning for patients with CHD.},
	language = {eng},
	number = {4},
	journal = {The Annals of Thoracic Surgery},
	author = {Jones, Shannon M. and McCracken, Courtney and Alsoufi, Bahaaldin and Mahle, William T. and Oster, Matthew E.},
	year = {2018},
	pmid = {29753820},
	keywords = {Biomarkers, Cardiac Surgical Procedures, Child, Preschool, Cohort Studies, Female, Heart Defects, Congenital, Hospital Mortality, Humans, Infant, Infant, Newborn, Kaplan-Meier Estimate, Length of Stay, Linear Models, Lymphopenia, Male, Neutropenia, Postoperative Complications, Preoperative Care, Prognosis, Retrospective Studies, Risk Assessment, Survival Rate, Thrombocytopenia, Treatment Outcome},
	pages = {1234--1240}
}

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E."],"year":2018,"bibtype":"article","biburl":"https://api.zotero.org/users/4975314/collections/KB3V7HT7/items?key=8kJrLC7IFZTfdh05dW1bnzbi&format=bibtex&limit=100","bibdata":{"bibtype":"article","type":"article","title":"Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease","volume":"106","issn":"1552-6259","doi":"10.1016/j.athoracsur.2018.04.022","abstract":"BACKGROUND: We examined the association of preoperative cell count abnormalities, which have been shown to be associated with outcomes in adult cardiac patients, with morbidity and mortality after operation for congenital heart disease (CHD) in children. METHODS: We performed a retrospective cohort study on 4,865 children undergoing cardiac operation from 2004 to 2014. Our exposures of interest were presence of preoperative lymphopenia (lymphocyte count ≤ 3,000 cells/μL), thrombocytopenia (platelet count \\textless 150 × 103/μL), and neutrophilia (neutrophil count ≥ 7,000 cells/μL). Our outcomes of interest were mortality status, postoperative length of stay (LOS), and occurrence of postoperative complications. We performed logistic and linear regressions to determine the associations of preoperative cell counts with mortality, LOS, and complications, adjusting for age, sex, race or ethnicity, presence of a genetic syndrome, and Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality category. RESULTS: Overall mortality was 2.8%, median LOS was 6 days, and 7.6% of patients had postoperative complications. Lymphopenia was associated with increased odds of postoperative mortality (odds ratio 1.67, 95% confidence interval: 1.15 to 2.43, p = 0.007). Lymphopenia, thrombocytopenia, and neutrophilia were all associated with longer postoperative LOS. Lymphopenia and thrombocytopenia were associated with increased occurrence of postoperative sepsis, and neutrophilia was associated with need for postoperative mechanical circulatory support. CONCLUSIONS: In children undergoing CHD operation, preoperative lymphopenia is associated with increased in-hospital mortality postoperatively. Preoperative lymphopenia, neutrophilia, and thrombocytopenia are associated with longer postoperative LOS and with development of postoperative complications. Preoperative cell counts may serve as important prognostic markers in preoperative planning for patients with CHD.","language":"eng","number":"4","journal":"The Annals of Thoracic Surgery","author":[{"propositions":[],"lastnames":["Jones"],"firstnames":["Shannon","M."],"suffixes":[]},{"propositions":[],"lastnames":["McCracken"],"firstnames":["Courtney"],"suffixes":[]},{"propositions":[],"lastnames":["Alsoufi"],"firstnames":["Bahaaldin"],"suffixes":[]},{"propositions":[],"lastnames":["Mahle"],"firstnames":["William","T."],"suffixes":[]},{"propositions":[],"lastnames":["Oster"],"firstnames":["Matthew","E."],"suffixes":[]}],"year":"2018","pmid":"29753820","keywords":"Biomarkers, Cardiac Surgical Procedures, Child, Preschool, Cohort Studies, Female, Heart Defects, Congenital, Hospital Mortality, Humans, Infant, Infant, Newborn, Kaplan-Meier Estimate, Length of Stay, Linear Models, Lymphopenia, Male, Neutropenia, Postoperative Complications, Preoperative Care, Prognosis, Retrospective Studies, Risk Assessment, Survival Rate, Thrombocytopenia, Treatment Outcome","pages":"1234–1240","bibtex":"@article{jones_association_2018,\n\ttitle = {Association of {Preoperative} {Cell} {Counts} {With} {Outcomes} {After} {Operation} for {Congenital} {Heart} {Disease}},\n\tvolume = {106},\n\tissn = {1552-6259},\n\tdoi = {10.1016/j.athoracsur.2018.04.022},\n\tabstract = {BACKGROUND: We examined the association of preoperative cell count abnormalities, which have been shown to be associated with outcomes in adult cardiac patients, with morbidity and mortality after operation for congenital heart disease (CHD) in children.\nMETHODS: We performed a retrospective cohort study on 4,865 children undergoing cardiac operation from 2004 to 2014. Our exposures of interest were presence of preoperative lymphopenia (lymphocyte count ≤ 3,000 cells/μL), thrombocytopenia (platelet count {\\textless} 150 × 103/μL), and neutrophilia (neutrophil count ≥ 7,000 cells/μL). Our outcomes of interest were mortality status, postoperative length of stay (LOS), and occurrence of postoperative complications. We performed logistic and linear regressions to determine the associations of preoperative cell counts with mortality, LOS, and complications, adjusting for age, sex, race or ethnicity, presence of a genetic syndrome, and Society of Thoracic Surgeons and European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality category.\nRESULTS: Overall mortality was 2.8\\%, median LOS was 6 days, and 7.6\\% of patients had postoperative complications. Lymphopenia was associated with increased odds of postoperative mortality (odds ratio 1.67, 95\\% confidence interval: 1.15 to 2.43, p = 0.007). Lymphopenia, thrombocytopenia, and neutrophilia were all associated with longer postoperative LOS. Lymphopenia and thrombocytopenia were associated with increased occurrence of postoperative sepsis, and neutrophilia was associated with need for postoperative mechanical circulatory support.\nCONCLUSIONS: In children undergoing CHD operation, preoperative lymphopenia is associated with increased in-hospital mortality postoperatively. Preoperative lymphopenia, neutrophilia, and thrombocytopenia are associated with longer postoperative LOS and with development of postoperative complications. Preoperative cell counts may serve as important prognostic markers in preoperative planning for patients with CHD.},\n\tlanguage = {eng},\n\tnumber = {4},\n\tjournal = {The Annals of Thoracic Surgery},\n\tauthor = {Jones, Shannon M. and McCracken, Courtney and Alsoufi, Bahaaldin and Mahle, William T. and Oster, Matthew E.},\n\tyear = {2018},\n\tpmid = {29753820},\n\tkeywords = {Biomarkers, Cardiac Surgical Procedures, Child, Preschool, Cohort Studies, Female, Heart Defects, Congenital, Hospital Mortality, Humans, Infant, Infant, Newborn, Kaplan-Meier Estimate, Length of Stay, Linear Models, Lymphopenia, Male, Neutropenia, Postoperative Complications, Preoperative Care, Prognosis, Retrospective Studies, Risk Assessment, Survival Rate, Thrombocytopenia, Treatment Outcome},\n\tpages = {1234--1240}\n}\n\n","author_short":["Jones, S. M.","McCracken, C.","Alsoufi, B.","Mahle, W. T.","Oster, M. 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