From the Research
Postoperative leukocytosis typically lasts for 4 days after surgery, with the white blood cell count returning to near preoperative levels by the fourth postoperative day. This is based on the study by 1, which found that the average postoperative white blood cell count increased to approximately 3 × 10(6) cells/μL over the first 2 postoperative days and then declined to a level slightly higher than the preoperative level by Postoperative Day 4. The incidence of postoperative leukocytosis for all patients was 38%, and factors associated with postoperative leukocytosis included TKA, bilateral procedures, older age, and higher modified Charlson Comorbidity Index.
Key Points
- Postoperative leukocytosis is a normal physiological response to surgical trauma
- The peak in leukocytosis usually occurs within the first 24-48 hours following surgery
- The duration of leukocytosis can vary depending on several factors, including the type and extent of surgery, patient's overall health status, presence of complications, and individual immune response
- More invasive procedures like major abdominal or thoracic surgeries tend to produce more pronounced and longer-lasting leukocytosis compared to minor procedures
- Persistent leukocytosis beyond the expected timeframe, especially when accompanied by fever or other signs of infection, should prompt evaluation for postoperative complications
Evidence
The study by 1 provides the most relevant evidence for the duration of postoperative leukocytosis. However, other studies, such as 2, 3, 4, and 5, also provide some insights into the phenomenon of postoperative leukocytosis, although they may not be directly related to the question of duration. For example, the study by 2 found that leukopenia, rather than leukocytosis, was a common phenomenon immediately after endovascular surgery, while the study by 3 found that delayed postoperative leukocytosis was a poor prognostic sign in lung transplant recipients.
Clinical Implications
Regular monitoring of white blood cell counts during the postoperative period is essential to distinguish between normal physiological leukocytosis and pathological conditions requiring intervention. Clinicians should be aware of the potential for postoperative leukocytosis and its duration, as well as the factors that can influence its severity and duration. By doing so, they can provide better care for their patients and reduce the risk of postoperative complications.