Association of Preoperative Cell Counts With Outcomes After Operation for Congenital Heart Disease
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Updated: Feb 10, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Shannon M Jones1, Courtney McCracken2, Bahaaldin Alsoufi3
1Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
Insights
Preoperative low lymphocyte counts (lymphopenia) increase mortality risk in pediatric heart surgery patients. Abnormal cell counts like lymphopenia, neutrophilia, and thrombocytopenia also correlate with longer hospital stays and more complications.
Area of Science:
- Pediatric Cardiology
- Hematology
- Surgical Outcomes
Background:
- Preoperative cell count abnormalities are linked to outcomes in adult cardiac surgery.
- The association in pediatric congenital heart disease (CHD) patients is less understood.
Purpose of the Study:
- To investigate the relationship between preoperative cell count abnormalities and outcomes in children undergoing cardiac surgery for CHD.
- To identify potential prognostic markers for preoperative planning.
Main Methods:
- Retrospective cohort study of 4,865 children from 2004-2014.
- Examined preoperative lymphopenia, thrombocytopenia, and neutrophilia.
- Assessed associations with mortality, length of stay (LOS), and complications using regression analysis, adjusting for covariates.
Main Results:
- Lymphopenia was associated with increased odds of postoperative mortality (OR 1.67).
- Lymphopenia, thrombocytopenia, and neutrophilia were linked to longer postoperative LOS.
- Lymphopenia and thrombocytopenia correlated with increased sepsis; neutrophilia with need for mechanical support.
Conclusions:
- Preoperative lymphopenia is a significant predictor of increased in-hospital mortality after pediatric CHD operations.
- Preoperative lymphopenia, neutrophilia, and thrombocytopenia are associated with adverse postoperative outcomes, including longer LOS and complications.
- Preoperative cell counts may serve as valuable prognostic indicators in pediatric CHD surgical planning.
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 < 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.
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