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  • Title: Lymphocyte depression as a predictor of postoperative intraabdominal abscess after appendectomy in children.
    Author: Lodwick DL, Cooper JN, Kenney B, Deans KJ, Minneci PC, Thakkar RK.
    Journal: J Pediatr Surg; 2017 Jan; 52(1):93-97. PubMed ID: 27836359.
    Abstract:
    BACKGROUND: This study evaluated the efficacy of lymphopenia to predict postappendectomy intraabdominal abscess (IAA) in pediatric complex appendicitis. METHODS: This single-center retrospective cohort study included appendectomy patients with complex appendicitis from 4/2012 to 10/2014. IAA was diagnosed based on imaging or undergoing a drainage procedure. Labs were used from the closest day prior to abscess diagnosis or day of discharge from index admission. Lymphocyte percentage was categorized based on age-specific cutoffs with lymphopenia defined as a low percentage. Comparisons were made using chi-square or Fisher exact tests for categorical variables and Mann-Whitney U-tests for continuous variables. RESULTS: Of 611 appendectomy patients with complicated appendicitis, 551 had WBC and differential. IAA was identified in 79 (12.9%) patients. There were no significant differences in demographics between IAA and non-IAA groups. Patients with IAA had higher rates of leukocytosis (44.3% versus 12.3%, p<0.001) and higher rates of age-based lymphopenia (84% vs. 46%, p<0.001). IAA was independently associated with leukocytosis (OR 3.65, p<0.001) and lymphopenia (OR 4.46, p<0.001). Patients with leukocytosis and lymphopenia had the highest abscess rate (36%), and those with normal labs had the lowest (3%, p<0.001). CONCLUSIONS: Lymphocyte depression is a useful adjunct to predict postoperative IAA in patients with complicated appendicitis. LEVEL OF EVIDENCE: III.
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