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Appendectomy and Cholecystectomy Outcomes for Pediatric Cancer Patients with Leukopenia: A NSQIP-Pediatric Study
Palak P Patel1, Jennine H Weller2, Carly R Westermann3
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Pediatric cancer patients with leukopenia (low white blood cell count) undergoing appendectomy or cholecystectomy did not experience worse surgical outcomes. These findings suggest surgery is safe for these young patients.
Area of Science:
- Pediatric Surgery
- Oncology
- Hematology
Background:
- Leukopenia is common in children with cancer, potentially complicating wound healing and surgical outcomes.
- The optimal management of acute surgical conditions in leukopenic pediatric cancer patients is not well-defined.
- This study investigates the impact of preoperative leukopenia on postoperative results in children with cancer undergoing appendectomy or cholecystectomy.
Purpose of the Study:
- To evaluate the association between preoperative leukopenia and postoperative outcomes in pediatric cancer patients undergoing appendectomy or cholecystectomy.
- To determine if leukopenia increases the risk of complications or length of stay after these common surgical procedures.
Main Methods:
- Retrospective analysis of pediatric cancer patients from the National Surgical Quality Improvement Program-Pediatric database (2012-2018).
- Comparison of demographics and perioperative characteristics based on leukopenia status (WBC <4 vs. ≥4 × 10^3/mL).
- Multivariate regression analysis of postoperative length of stay and 30-day composite complications (infections, reoperations, readmissions).
Main Results:
- Leukopenia was present in 41.0% of appendectomy and 56.4% of cholecystectomy cases.
- Postoperative complications occurred in 8.4% of appendectomy and 5.9% of cholecystectomy patients.
- Multivariate analysis revealed no significant association between leukopenia and increased postoperative complications or length of stay for either procedure.
Conclusions:
- Preoperative leukopenia in pediatric cancer patients does not lead to worse short-term surgical outcomes after appendectomy or cholecystectomy.
- Operative management for appendicitis and cholecystitis appears safe in leukopenic pediatric cancer patients.
- These findings support the safety of surgical intervention for these conditions in this vulnerable population.
Background:
Children with cancer often develop leukopenia which may impair wound healing and increase surgical complication rates. When leukopenic children with cancer develop an acute surgical condition, the optimal management strategy remains unclear. This study examined the effect of preoperative leukopenia on postoperative outcomes in children with cancer who underwent an appendectomy or cholecystectomy.
Methods:
We retrospectively identified cancer patients undergoing an appendectomy or cholecystectomy from the National Surgical Quality Improvement Program-Pediatric database from 2012-2018. Demographics and perioperative characteristics were compared by leukopenia status (WBC <4 vs. ≥4 × 10^3/mL). Postoperative length of stay (LOS) and 30-day composite complications, including infections, reoperations, and readmissions, were analyzed for each procedure using multivariate regression.
Results:
There were 227 children who underwent an appendectomy and 101 children who underwent a cholecystectomy. Leukopenia was seen in 93 (41.0%) appendectomy and 57 (56.4%) cholecystectomy cases. Nineteen (8.4%) appendectomy patients and six (5.9%) cholecystectomy patients developed a postoperative complication. The median postoperative LOS was 2 days (IQR 1-6 days) for appendectomy and 1 day (IQR 1-2.5 days) for cholecystectomy cases. After multivariate analyses, leukopenia was not associated with increased postoperative complications after an appendectomy (OR 0.55, P = 0.36) or cholecystectomy (OR 0.39, P = 0.37). There was no significant difference in postoperative LOS based on leukopenia status for children who underwent an appendectomy (P = 0.82) or cholecystectomy (P = 0.37).
Conclusion:
In pediatric cancer patients, leukopenia was not associated with increased short-term postoperative complications or longer postoperative LOS after either an appendectomy or cholecystectomy. These results support that operative management can be performed safely in pediatric appendicitis and cholecystitis in leukopenic cancer patients.
