Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery: A prospective multicentre
Ludivine Petit1, Bruno Pastene, Guillaume Dupont
1From the Département d'Anesthésie-Réanimation, Université Jean Monnet Saint Etienne, CHU Saint Etienne, F-42023, Saint Etienne, France (LP, GD, LF SM), the Service d'Anesthésie et de Réanimation, Université d'Aix Marseille, Assistance Publique Hôpitaux de Marseille,, Hôpital Nord, Marseille, France (BP, JA, ML), the Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France (BB, PI), the Service d'Anesthésie Réanimation & Médecine Péri-opératoire, Centre Hospitalier Universitaire de Poitiers, Poitiers, 86021, France; Inserm U1070, Université de Poitiers, Poitiers, France (PAG, MB), the Service d'Anesthésie et de Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, 69500, Lyon, France (JLF), the Département Anesthésie et Réanimation, Centre Hospitalier Universitaire Nîmes, Nîmes, France (YG), the Service d'Anesthésie, Centre hospitalier et universitaire de Lille, F-59037 Lille, France (GL), the Service Anesthésie et Réanimation, Centre Medico-chirurgical Magellan, Centre Hospitalier Universitaire de Bordeaux, Pessac, France (AO), the Département d'Anesthésie et de Réanimation, Centre Hospitalier Universitaire de Caen, Caen, France (MOF), Service d'Anesthésie-Réanimation Chirurgicale NHC - Hôpitaux Universitaires de Strasbourg, 67094 Strasbourg cedex, France (PMM), AP-HP, 26930, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, F-75013, Paris, Île-de-France, France (DE), the Département d'Anesthésie et de Réanimation, Centre Hospitalier Universitaire, Dijon, France (BB), the Département d'Anesthésie, Réanimation et Médecine Périopératoire, Groupe Hospitalier Universitaire Cochin, Paris, France (AG), AP-HP Nord, the Département d'Anesthésie Réanimation, CHU Bichat-Claude-Bernard, Paris, France. Université Paris-Cité, France (PM), the Laboratoire d'immunologie et EA7426, Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France (GM), the Département d'Anesthésie et de Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France (ACL), Direction de la Recherche Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Unité de Biostatistiques, Clermont-Ferrand, France (BP).
Background:
Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs).
Objectives:
We aimed to determine whether postoperative lymphopaenia following thoracic or gastrointestinal cancer surgery is an independent risk factor for PIs and to identify modifiable factors related to anaesthesia and surgical procedures that might affect its occurrence.
Study Design:
The EVALYMPH study was a prospective, multicentre cohort study with a 30-day patient follow-up. Multivariate analyses were performed to determine the risk factors for PIs and for postoperative lymphopaenia.
Setting:
Patients were included from January 2016 to September 2017 in 25 French centres.
Patients:
Adult patients admitted for thoracic or gastrointestinal cancer surgery were eligible for inclusion.
Main Outcome Measure:
PIs within 30 days after surgery were defined as urinary tract infections, pneumonia, surgical site infections and other infections (bloodstream infections or pleurisy).
Results:
Of 1207 patients included, 273 (22.6%) developed at least one infection within 30 days after surgery, with a median [IQR] time to onset of 8 [5 to 11] days. An increased risk of PI was significantly associated with an ASA score of IV: hazard ratio (HR) 4.27 (95% confidence interval (CI), 1.87 to 9.72), surgery > 200 min (HR 1.58 (1.15 to 2.17) and lymphopaenia on postoperative day 1 (POD1) (HR 1.56 (1.08 to 2.25). This risk was associated with changes in postoperative LC over time ( P = 0.001) but not with preoperative LC ( P = 0.536).POD1 lymphopenia was related to patient characteristics and duration of surgery but not to potentially modifiable other surgical or anaesthetics factors.
Conclusions:
POD1 lymphopaenia was associated with PIs in patients undergoing thoracic or gastrointestinal cancer surgery. To individualise care, patient characteristics and surgery duration should be taken into account.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02799251.
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