Preoperative Leukocytosis Among Female Patients Predicts Poor Postoperative Outcomes Following EVAR For Intact Infrarenal AAA.

OBJECTIVES Elevated white blood count (WBC) can be predictive of adverse outcomes following vascular interventions, but the association has not established using multi-institutional data. We evaluated the predictive value of preoperative WBC after endovascular abdominal aortic aneurysm repair (EVAR) for non-ruptured abdominal aortic aneurysms (AAA) in a nationally representative surgical database. METHODS Patients with non-ruptured AAA undergoing EVAR were identified in the vascular-targeted National Surgical Quality Improvement Program (NSQIP) database. Baseline characteristics were compared between patients with WBC 1 week, 30-day readmission, lower extremity (LE) ischemia, ischemic colitis, myocardial infarction (MI) and others were assessed based on WBC and patient sex. RESULTS A total of 10955 patients were included with a mean WBC 7.7 ± 2.7 K/μL. Patients with WBC ≥ 10 K/μL were younger (71.8 ± 9.5 years versus 74.1 ± 8.7 years; P 1 week (13.5% versus 6.7%), 30-day readmissions (9.8% versus 7.3%), LE ischemia (2.3% vs 1.4%), ischemic colitis (1.2% vs 0.5%), and MI (2.0% vs 1.1% ) (all P ≤ .008). Female patients with WBC ≥ 10 K/μL, compared to male patients with WBC ≥ 10 K/μL had more adverse events including mortality, LOS > 1 week, 30-day readmission, LE ischemia (all P ≤ .025). With each incremental increase in WBC by 1K/μL, the adjusted odds ratio of adverse outcomes for all patient was higher (mortality: 1.05 [95% CI, 1.00-1.10], readmission: 1.03 [95% CI, 1.00-1.06], LOS > 1 week: 1.08 [95% CI, 1.05-1.10] and ischemic colitis: 1.11 [95% CI, 1.05-1.16]; all P < .05). The effect was more pronounced in female patients and statistically significant. CONCLUSIONS WBC is a predictor of adverse outcomes in patients undergoing EVAR for non-ruptured AAA. After adjusting for associated risk factors, the effect of increasing WBC was more prominent for female patients. Preoperative WBC should be used as a prognostic factor to predict adverse outcomes among EVAR patients.