Appendectomy and Cholecystectomy Outcomes for Pediatric Cancer Patients with Leukopenia: A NSQIP-Pediatric Study

Palak P Patel; Jennine H Weller; Carly R Westermann; Clint Cappiello; Alejandro V Garcia; Daniel S Rhee

doi:10.1016/j.jss.2021.06.029

Appendectomy and Cholecystectomy Outcomes for Pediatric Cancer Patients with Leukopenia: A NSQIP-Pediatric Study

J Surg Res. 2021 Nov:267:556-562. doi: 10.1016/j.jss.2021.06.029. Epub 2021 Jul 11.

Authors

Palak P Patel¹, Jennine H Weller², Carly R Westermann³, Clint Cappiello², Alejandro V Garcia², Daniel S Rhee⁴

Affiliations

¹ Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland.
³ Virginia Polytechnic State Institution and University, Blacksburg, Virginia.
⁴ Department of Surgery, Johns Hopkins School of Medicine, Baltimore Maryland. Electronic address: drhee1@jhmi.edu.

PMID: 34261006
DOI: 10.1016/j.jss.2021.06.029

Abstract

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.

Keywords: Appendectomy; Cholecystectomy; Leukopenia; Pediatric cancer.

MeSH terms

Appendectomy / methods
Appendicitis* / surgery
Child
Cholecystectomy / adverse effects
Humans
Length of Stay
Leukopenia* / complications
Leukopenia* / etiology
Neoplasms* / complications
Neoplasms* / surgery
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Retrospective Studies