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Lymphocyte depression as a predictor of postoperative intraabdominal abscess after appendectomy in children
Daniel L Lodwick1, Jennifer N Cooper1, Brian Kenney2
1Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
Insights
Lymphopenia, a low lymphocyte count, effectively predicts intraabdominal abscess (IAA) after pediatric complex appendicitis surgery. Combining lymphopenia with leukocytosis further increases abscess prediction accuracy.
Area of Science:
- Pediatric Surgery
- Infectious Disease
- Hematology
Background:
- Intraabdominal abscess (IAA) is a complication of appendectomy for complex appendicitis.
- Predictive markers for postappendectomy IAA are crucial for patient management.
Purpose of the Study:
- To evaluate the efficacy of lymphopenia in predicting postappendectomy IAA in pediatric patients with complex appendicitis.
Main Methods:
- Retrospective cohort study of 611 pediatric complex appendicitis patients.
- Lymphocyte percentage analyzed from pre-operative or discharge labs.
- Lymphopenia defined by age-specific cutoffs; IAA diagnosed via imaging or drainage.
Main Results:
- IAA occurred in 12.9% of patients.
- Patients with IAA showed significantly higher rates of leukocytosis (44.3%) and lymphopenia (84%) compared to those without IAA.
- Lymphopenia was independently associated with IAA (OR 4.46).
- The combination of leukocytosis and lymphopenia yielded the highest abscess rate (36%).
Conclusions:
- Lymphocyte depression (lymphopenia) serves as a valuable adjunct marker for predicting post-operative IAA in pediatric complex appendicitis.
- Identifying patients with both leukocytosis and lymphopenia can help anticipate higher risk for abscess formation.
Background:
This study evaluated the efficacy of lymphopenia to predict postappendectomy intraabdominal abscess (IAA) in pediatric complex appendicitis.
Methods:
This single-center retrospective cohort study included appendectomy patients with complex appendicitis from 4/2012 to 10/2014. IAA was diagnosed based on imaging or undergoing a drainage procedure. Labs were used from the closest day prior to abscess diagnosis or day of discharge from index admission. Lymphocyte percentage was categorized based on age-specific cutoffs with lymphopenia defined as a low percentage. Comparisons were made using chi-square or Fisher exact tests for categorical variables and Mann-Whitney U-tests for continuous variables.
Results:
Of 611 appendectomy patients with complicated appendicitis, 551 had WBC and differential. IAA was identified in 79 (12.9%) patients. There were no significant differences in demographics between IAA and non-IAA groups. Patients with IAA had higher rates of leukocytosis (44.3% versus 12.3%, p<0.001) and higher rates of age-based lymphopenia (84% vs. 46%, p<0.001). IAA was independently associated with leukocytosis (OR 3.65, p<0.001) and lymphopenia (OR 4.46, p<0.001). Patients with leukocytosis and lymphopenia had the highest abscess rate (36%), and those with normal labs had the lowest (3%, p<0.001).
Conclusions:
Lymphocyte depression is a useful adjunct to predict postoperative IAA in patients with complicated appendicitis.
Level Of Evidence:
III.
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