Postoperative inflammatory responses and association with in-hospital mortality after general surgery

The relationship between postoperative in-hospital mortality and inflammatory markers has not been well described. This study aimed to characterize the association between specific clinical markers of inflammation and in-hospital mortality in the early postoperative period in general surgical patients.

This study included consecutive general surgery admissions at two tertiary hospitals in South Australia over a 2-year period. Collected data included patient demographics, Charlson comorbidity index, in-hospital mortality, vital signs, and laboratory tests. In particular, temperature, neutrophil count, lymphocyte count, platelet count, albumin level, and C-reactive protein (CRP) were collected for the 48 h after surgery. Multivariable logistic regression was conducted to examine the association between clinical inflammatory markers and in-hospital mortality in the first 24 h postoperatively and 24-48 h postoperatively.

5493 patients were included, with an average age of 52.8 (SD 19.4). 2548 (46.4%) were female, and 53 (1.0%) experienced in-hospital mortality. In the first 24 h postoperatively, temperature >38°C, neutrophil count >14 × 10⁹/L, and a lymphocyte count >5 × 10⁹/L were significantly associated with an increased likelihood of in-hospital mortality, whereas platelets, albumin, and CRP during were not. Between 24 and 48 h postoperatively, increases in maximum neutrophil counts, lymphocyte counts, and platelet counts were significantly associated with an increased likelihood of in-hospital mortality, whereas changes in temperature, albumin, and CRP were not.

This is the first study to characterize the inflammatory response using specific clinical laboratory markers, and their relative association with in-hospital mortality, in the first 2 days after general surgery.