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International Journal of Inflammation
Volume 2013 (2013), Article ID 781024, 7 pages
http://dx.doi.org/10.1155/2013/781024
Research Article

Preoperative White Blood Cell Count and Risk of 30-Day Readmission after Cardiac Surgery

1The 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
2Edmund Cohen Laboratory for Vascular Research, The University of the West Indies, Bridgetown, Barbados
3Department of Surgery, Concord Hospital, Concord, NH, USA
4Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
5Department of Surgery, Portsmouth Regional Hospital, Portsmouth, NH, USA
6Department of Surgery, Central Maine Medical Center, Lewiston, ME, USA
7Department of Surgery, Eastern Maine Medical Center, Bangor, ME, USA
8Department of Surgery, Maine Medical Center, Portland, ME, USA
9Department of Surgery, Catholic Medical Center, Manchester, NH, USA

Received 24 April 2013; Revised 26 June 2013; Accepted 26 June 2013

Academic Editor: Paulo Roberto Barbosa Evora

Copyright © 2013 Jeremiah R. Brown et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 mm3) had higher 30-day readmission than those with lower levels of WBC count prior to surgery (15% and 18% compared to 10%–12%, ). 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.