P-BN49 The predictive role of white cell and platelet count for infective complications following splenectomy. (16th December 2021)

• Record Type: Journal Article
• Authors: Karadakhy, Ozhin; Poynton-Smith, Emma; Beckingham, Ian
• Is Part Of: British journal of surgery. Volume 108:Supplement 9(2021)
• Publication Date: 2021-12-16
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab430.047
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Temporary elevation of white cell count (WCC) and platelets are commonly observed after splenectomy and can therefore make it difficult for the surgeon to distinguish a normal physiological response from potential infection. Clinicians are often misled by elevated post-operative WCC after splenectomy, resulting in delayed discharges and prolonged unnecessary hospital stays for patients. The aim of this study was to establish what constitutes a normal rise in WCC and platelets after splenectomy. Methods: All 127 patients who had undergone a splenectomy between July 2016 and January 2021 were identified from a search of our centre's hospital episode statistics data. WCC and platelet count on post-operative days one to seven as well as at least one long-term follow-up result count were identified from electronic hospital records. Hospital records were searched for data on pre-operative steroid administration and peri-operative infections. These cohort data were retrospectively analysed in SPSS using stepwise logistic regression, correlation analysis, and T-tests, as well as descriptive statistics. Results: 86 (68%) patients underwent an elective splenectomy and 41 (32%) an emergency splenectomy. 35 (27.6%) patients developed infections post-operatively, while 92 (72.4%) did not. Logistic regression suggested that a raised WCC (above 17.5x10 9 /L) at day 3 post-op was a significant predictor of infection (p < 0.001): average WCC at day 3 for patients with infection was 20.00x10 9 /L (SD = 6.23x10 9 /L) compared to 14.86x10 9 /L (SD = 4.01x10 9 /L) for those without. Infective outcomes were not influenced by whether the surgery was emergency or elective. Overall, average WCCs were 9.63x10 9 /L pre-operatively and 15.07x10 9 /L long-term post-operatively. Even in the absence of infection, splenectomy led to a long-term rise in WCC of 3.8x10 9 /L from baseline, to an average of 13.0x10 9 /L [SD = 5.41x10 9 /L): a T-test on the 56 patients without infection and with both pre-op and long-term WCCs showed a mean rise of 3.76x10 9 /L, p < 0.0001). Platelet count was not correlated with infection, though platelet counts rose from a mean of 261 × 10 9 /L (SD = 103.4x10 9 /L) pre-operatively to 581 × 10 9 /L (SD = 236.3x10 9 /L) at 7-day and 619 × 10 9 /L (SD = 293.5x10 9 /L) at long-term follow up across all patients – an average increase of 357 × 10 9 /L, which did not significantly differ between patients with and without infective complications. Conclusions: A rise in WCC and platelet count is normal post-splenectomy. A rise in WCC>17.5x10 9 /L on day 3 post-splenectomy is strongly correlated with infection (regardless of trauma or platelet count). Long-term follow up suggests that while much of the WCC increase is transient, WCC remains higher than pre-operatively, as does platelet count, in post-splenectomy patients. A raised WCC or platelet count without signs of infection should not preclude timely discharge in otherwise well patients.