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. 2025 Jun 2;35(1):227.
doi: 10.1007/s00590-025-04343-z.

Leukopenia and leukocytosis are associated with early postoperative complications following aseptic revision total shoulder arthroplasty

Steven H Liu  1 , Rustin Mahboubi Ardakani  2 , Rachel A Loyst  2 , Allen Bramian  2 , Edward D Wang  2
Affiliations

Leukopenia and leukocytosis are associated with early postoperative complications following aseptic revision total shoulder arthroplasty

Steven H Liu et al. Eur J Orthop Surg Traumatol. .

Abstract

Background: This study investigates the association between preoperative leukopenia and leukocytosis with 30-day postoperative complications following noninfectious revision total shoulder arthroplasty (TSA).

Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent noninfectious revision TSA from 2015 to 2022. The study population was divided into three groups based on preoperative white blood cell (WBC) count: normal (WBC 4500-11,000), leukopenia (WBC ≤ 4500), and leukocytosis (WBC ≥ 11,000). Logistic regression analysis was conducted to investigate the relationship between WBC count and postoperative complications.

Results: Compared to normal WBC counts, leukocytosis was independently associated with an increased likelihood of experiencing any complication (OR 1.71, 95% CI 1.13-2.59; P = 0.012), sepsis (OR 5.31, 95% CI 1.38-20.37; P = 0.015), non-home discharge (OR 2.18, 95% CI 1.18-4.05; P = 0.013), readmission (OR 2.76, 95% CI 1.36-5.63; P = 0.005), and LOS > 2 days (OR 1.68, 95% CI 1.06-2.66; P = 0.028). Compared to normal WBC counts, leukopenia was independently associated with an increased likelihood of experiencing pneumonia (OR 14.98, 95% CI 2.32-96.56; P = 0.004) and readmission (OR 2.78, 95% CI 1.49-5.17; P = 0.001).

Conclusion: The present study identified preoperative leukocytosis and leukopenia as independent risk factors for 30-day postoperative complications following revision TSA. Integrating WBC count into preoperative assessments can enhance the identification of patients at risk for postoperative complications, allowing for more tailored management strategies and potentially improving overall patient outcomes.

Keywords: Complications; Leukocytosis; Leukopenia; Revision total shoulder arthroplasty; Total shoulder arthroplasty; White blood cells.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Case selection schematic. TSA, total shoulder arthroplasty; NSQIP, National Surgical Quality Improvement Program; WBC, white blood cell; ASA, American Society of Anesthesiologists
See this image and copyright information in PMC

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