Correlation Between Intraoperative Dexamethasone Administration and Leukocyte Count On Post-operative Day Number One in Laparoscopic Gastric Bypass Patients

David R Donahue, DO, Kevan E Mann, MD. Naval Medical Center Portsmouth

Background:

We hypothesize that a single dose of perioperative steroids cause a leukocytosis on post-operative day one in laparoscopic gastric bypass patients.  One of the most recognized uses of perioperative dexamethasone is for the prevention of post-operative nausea and vomiting. One of the most feared complications in bariatric surgery is that of an anastomotic leak.  In our bariatric patient population, intraoperative steroids are often given to help control post-operative nausea and vomiting. These patients follow a very regimented protocol after surgery with discharge typically occurring on post-operative day two.  A leukocytosis could cause a delay in this protocol while searching for a complication such as anastomotic leak. 

Methods:

We performed a retrospective chart review of all patients who underwent a laparoscopic gastric bypass in the period of 1/2008 through 8/2009 with documentation of whether dexamethasone was administered and the dose given. We then performed a computed t-test to evaluate if a correlation exists between administration of medication and elevated white count on post-operative day one. We also determined if there was a correlation between dose given and elevation of white count.

Results:

The results show a statistically significant difference in WBC count between those who received dexamethasone and those who did not. The mean count in those who received a dose was 11.6 versus 10.7 in those who did not receive dexamethasone (p=.036). There was no correlation between dose of dexamethasone and white blood cell count (p=.317).

Conclusions:

We hypothesized that a single dose of intraoperative steroids cause a leukocytosis in the post-operative period.  Our data shows that there is a statistically significant elevation in leukocyte count in patients who receive dexamethasone intraoperatively. This needs to be taken into account when determining the cause of a leukocytosis since the post-operative course may be altered unnecessarily searching for a complication.
 

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