Implications of leukocytosis following distal pancreatectomy splenectomy (DPS) and association with postoperative complications

Background Early identification of complications after distal pancreatectomy splenectomy (DPS) poses challenges, as white blood cell count (WBC) is confounded by physiologic leukocytosis. We examined WBC patterns associated with complications after DPS. Methods Clinicopathologic data were collected for patients who underwent DPS in our system from 2009 to 2016. We examined WBC, temperature, platelet count (PC), and ratios of these variables as potential early indicators of patients at risk of infections or major complications (MCs). Results 348 patients met study inclusion, of whom 206 (59%) were women and the median patient age was 59 +/- 15 years. Infectious and MC rates were 11% and 16%, respectively, with <1% 30-day mortality. Postoperative WBC peaks were higher in patients with infections and MCs compared with no complication (23 vs. 17, p < 0.0001). WBC peak timing occurred postoperative day (POD) 2-3 for uncomplicated cases while peaks occurred POD9 for patients with infections and MCs. Discussion These data define patterns of leukocytosis following DPS. Although differences in infection markers were identified for patients with and without complications, no obvious thresholds were identified. Clinical suspicion for complications after DPS remains our best tool for early identification.

Automated summary

This study investigated the association between white blood cell count (WBC) and infections or major complications (MCs) after distal pancreatectomy splenectomy (DPS). The results showed that patients with infections and MCs had higher postoperative WBC peaks compared to those without complications, and the timing of these peaks also differed. However, no clear thresholds were identified to determine the presence of complications, and clinical suspicion remains the best tool for early identification.