title: Preoperative white blood cell count and risk of 30-day readmission after cardiac surgery.
abstract: Approximately 1 in 5 patients undergoing cardiac surgery are readmitted within 30 days of discharge. Among the primary causes of readmission are infection and disease states susceptible to the inflammatory cascade, such as diabetes, chronic obstructive pulmonary disease, and gastrointestinal complications. Currently, it is not known if a patient's baseline inflammatory state measured by crude white blood cell (WBC) counts could predict 30-day readmission. We collected data from 2,176 consecutive patients who underwent cardiac surgery at seven hospitals. Patient readmission data was abstracted from each hospital. The independent association with preoperative WBC count was determined using logistic regression. There were 259 patients readmitted within 30 days, with a median time of readmission of 9 days (IQR 4-16). Patients with elevated WBC count at baseline (10,000-12,000 and >12,000 mm(3)) had higher 30-day readmission than those with lower levels of WBC count prior to surgery (15% and 18% compared to 10%-12%, P = 0.037). Adjusted odds ratios were 1.42 (0.86, 2.34) for WBC counts 10,000-12,000 and 1.81 (1.03, 3.17) for WBC count > 12,000. We conclude that WBC count measured prior to cardiac surgery as a measure of the patient's inflammatory state could aid clinicians and continuity of care management teams in identifying patients at heightened risk of 30-day readmission after discharge from cardiac surgery.
authors: The Dartmouth Institute for Health Policy and Clinical Practice, Departments of Medicine Section of Cardiology and Community and Family Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors: Jeremiah R
authors: JR
authors: Brown
authors: R Clive
authors: RC
authors: Landis
authors: Kristine
authors: K
authors: Chaisson
authors: Cathy S
authors: CS
authors: Ross
authors: Lawrence J
authors: LJ
authors: Dacey
authors: Richard A
authors: RA
authors: Boss
authors: Robert E
authors: RE
authors: Helm
authors: Susan R
authors: SR
authors: Horton
authors: Patricia
authors: P
authors: Hofmaster
authors: Cheryl
authors: C
authors: Jones
authors: Helen
authors: H
authors: Desaulniers
authors: Benjamin M
authors: BM
authors: Westbrook
authors: Dennis
authors: D
authors: Duquette
authors: Kelly
authors: K
authors: Leblond
authors: Reed D
authors: RD
authors: Quinn
authors: Patrick C
authors: PC
authors: Magnus
authors: David J
authors: DJ
authors: Malenka
authors: Anthony W
authors: AW
authors: Discipio
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