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Ann Thorac Surg 2003;76:760-764
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

Preoperative white blood cell count and mortality and morbidity after coronary artery bypass grafting

^a Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
^b Department of Surgery, Maine Medical Center, Portland, Maine, USA
^c Department of Surgery, Fletcher-Allen Health Care, Burlington, Vermont, USA
^d Department of Surgery, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA
^e Department of Surgery, Eastern Maine Medical Center, Bangor, Maine, USA
^f Department of Surgery, Catholic Medical Center, Manchester, New Hampshire, USA
^g Departments of Medicine and Community & Family Medicine and the Center for the Evaluative Clinical Sciences, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA

Accepted for publication April 3, 2003.

^* Address reprint requests to Dr Dacey, Cardiothoracic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756-0001, USA.
e-mail: lawrence.j.dacey{at}dartmouth.edu

BACKGROUND: Arteriosclerosis is increasingly viewed as an inflammatory disease. The purpose of these analyses was to examine the preoperative white blood cell (WBC) count, a generalized marker of inflammation, and to assess its association with in-hospital mortality and other adverse outcomes after coronary artery bypass grafting.

METHODS: Information was collected prospectively on 11,270 consecutive patients who had isolated coronary artery bypass grafting in northern New England from 1996 through 2000. Patients were divided into five categories based on their preoperative WBC count. Crude and adjusted in-hospital mortality rates and adverse event rates were calculated using logistic regression.

RESULTS: Increasing WBC count across its entire range was associated with a linear increase in the mortality rate. This finding was highly significant (p [trend] < 0.001) and persisted after adjustment for patient and disease characteristics. Patients with preoperative WBC of at least 12.0 x 10⁹/L had an adjusted mortality rate 2.8 times higher than those with a WBC less than 6.0 x 10⁹/L (4.8% versus 1.7%). An increasing preoperative WBC count was also significantly associated with increasing rates of perioperative strokes and the need for an intraaortic balloon pump but was not associated with mediastinitis.

CONCLUSIONS: The preoperative WBC count across its entire observed range is a statistically significant independent predictor of in-hospital death and other adverse outcomes after coronary artery bypass grafting. Although the cause of the association between increased WBC count and increased morbidity and mortality is unknown, the preoperative WBC count, which is objectively measured, inexpensive, and always available, can serve as a useful marker to help predict risk before coronary artery bypass grafting.

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