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Association of Immediate Postoperative Leukocyte Count with Perioperative Outcomes
Jessica Cobb1, Gregory Fishberger1, Sarah M. Cool1, Collin Chase1, Ajay Varadhan1, Maykel Dolorit1, Harrison Strang1, Emily Weeden1, Diep Nguyen1, Rahul Mhaskar1, Joseph R. Garrett2, Carla C. Moodie2, Jacques P. Fontaine3, Jenna Tew2, Jobelle J.A.R. Baldonado3, Eric M. Toloza3.
1USF Morsani College of Medicine, Tampa, FL, USA, 2Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA, 3Department of Thoracic Oncology, Moffitt Cancer Center; Department of Surgery, University of South Florida Morsani College of Medicine; Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA.

Objective: The aim of this study was to evaluate perioperative outcomes after robotic video-assisted pulmonary lobectomy in patients with high compared to low/normal immediate postoperative leukocyte count, which is a marker of inflammation.
Methods: We retrospectively reviewed 709 patients who underwent robotic-assisted video-thoracoscopic pulmonary lobectomy completed by one surgeon over 10.8 years. Patients were grouped as either having High (≥11 k/uL) or Low/Normal (<11 k/uL) immediate postoperative leukocyte count. Our primary outcomes included skin-to-skin operative time. Secondary outcomes evaluated included intraoperative estimated blood loss (EBL), intraoperative and postoperative complications, chest tube duration, hospital length of stay, and in-hospital mortality. Statistical analysis of skin-to-skin operative time was done using the Wilcoxon Two-Sample Test. Fisher’s Exact Test was conducted when necessary.
Results: There were 280 patients with High immediate postoperative leukocyte counts and 429 with Low/Normal counts. High immediate postoperative leukocyte counts were associated with significantly higher skin-to-skin operative times (p<0.0001) and almost significantly higher intraoperative EBL (p=0.06) (Table 1). There were no significant differences in intraoperative or postoperative complications based on immediate postoperative leukocyte count. However, all incidences of postoperative shock/multiorgan system failure (MOSF) and postoperative pulmonary emboli occurred in the group with High immediate postoperative leukocyte counts (p=0.16 for both).
Conclusions: Median skin-to-skin operative time was significantly higher, and intraoperative EBL tended to be higher in patients with High leukocyte counts immediately following robotic-assisted video-thoracoscopic pulmonary lobectomy. High immediate postoperative leukocyte count was also associated with occurrences of postoperative shock/MOSF and postoperative pulmonary emboli.


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