Association of Preoperative Thrombocytosis and Leukocytosis With Postoperative Morbidity and Mortality Among Patients With Ovarian Cancer

Abstract

OBJECTIVE:

To examine whether preoperative thrombocytosis or leukocytosis is associated with increased postoperative morbidity or mortality.

METHODS:

Patients with ovarian cancer undergoing primary surgery from 2005 to 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Project. Thrombocytosis was defined as platelets greater than 450,000/mm and leukocytosis as white blood cells greater than 10,000/mm. We examined 30-day postoperative complications and mortality. Descriptive statistics and adjusted multivariable logistic regression were used for analysis.

RESULTS:

We identified 1,072 patients. The incidence of thrombocytosis was 9.6%, leukocytosis was 18.7%, and 4.9% had both.
Leukocytosis was associated with major complication (16.5% compared with 10.3%, P=.01) but not postoperative death (3.0% compared with 1.3%, P=.08). Thrombocytosis was also associated with major complication (19.4% compared with 10.7%, P<.01) but not postoperative death (2.9% compared with 1.5%, P=.30). Patients with both thrombocytosis and leukocytosis had increased rates of both major complication (22.6% compared with 10.9%, P<.001) and mortality (5.7% compared with 1.4%, P=.02). In logistic regression adjusting for age, comorbidities, and surgical complexity, major complication remained associated with thrombocytosis (adjusted odds ratio [OR] 2.16, 95% confidence interval [CI], 1.25-3.74, P<.01) and leukocytosis (adjusted OR 1.78, 95% CI, 1.13-2.80, P=.01). Additionally, thrombocytosis and leukocytosis together were associated with postoperative death (adjusted OR 5.4, 95% CI, 1.4-22.3, P=.02).

CONCLUSION:

Preoperative thrombocytosis or leukocytosis is associated with an increased risk of major postoperative complication. Patients with both thrombocytosis and leukocytosis experienced twice the rate of major complication and a fourfold increase in postoperative death.