Can neutrophil-lymphocyte ratio predict operators’ difficulty in early cholecystectomies; a retrospective cohort study

Ahmed, Salman E., Rehman, Shafiq, Edilbe, M., Jonker, Leon ORCID: https://orcid.org/0000-0001-5867-4663 and Canelo, Ruben (2017) Can neutrophil-lymphocyte ratio predict operators’ difficulty in early cholecystectomies; a retrospective cohort study. Annals of Emergency Surgery, 2 (3). art. 1016.

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Abstract

Background: Recent years has seen an increased trend toward “early cholecystectomy” following acute cholecystitis. Operators whilst performing cholecystectomy during acute cholecystitis commonly finds varying degree of inflammation ranging from soft omental adhesions to densely adherent gangrenous gall bladder, which is not only associated with morbidity but is often technically challenging. In this study we aim to retrospectively evaluate the role of neutrophil-lymphocyte ratio (NLR) and its association with operative difficulty and length of stay for patients who underwent ‘hot cholecystectomy’.

Methods: An anonymised retrospective single-centre cohort study using operative notes and clinical data. Chi-squared test and Mann-Whitney U-test were applied to determine significance between variables in the predetermined low NLR (<5) and high NLR (>5) groups. Multiple linear regression was applied for assessing any significant relationships between NLR and operative difficulty, length of stay (LOS) and post-operative stay (POS).

Results: Patients with a high NLR > 5 level upon admission are on average older (median 44 vs 60 years; p-value 0.003), have a longer hospital stay (median 4 vs 5 days; 0.005), their operations takes longer (median 81 vs. 98 minutes; p=0.026), and operations are deemed more difficult (13% vs. 33%; p=0.035) as judged by surgeons and evident by intra operative parameters. In linear regresseion increased age was found to be associated with higher NLR (p=0.035). Presence of gangrene was significantly associated with both LOS and POS in regression analysis (p-value 0.044 and 0.015 respectively).

Conclusions: In performing an ‘early cholecystectomy’ a higher NLR on admission is associated with operators’ difficulty. However, a NLR cut off of 5 is not significantly linked to increased length of stay. Nonetheless, NLR on admission can be applied to stratify acute cholecystitis to plan surgery and anticipate difficult operation. NLR when combined with age can be utilised as guide to prioritise the urgency of operation and as prognostic predictor of possible post op complications.

Item Type:	Article
Journal / Publication Title:	Annals of Emergency Surgery
Publisher:	JSciMed Central
ISSN:	2573-1017
Departments:	Academic Departments > Medical & Sport Sciences (MSS) > Health and Medical Sciences
Additional Information:	Leon Jonker of North Cumbria University Hospitals NHS Trust is an Honorary Research Fellow at the University of Cumbria, UK.
Depositing User:	Anna Lupton
Date Deposited:	17 Oct 2017 12:39
Last Modified:	12 Jan 2024 17:46
URI:	https://insight.cumbria.ac.uk/id/eprint/3327

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