Neutrophil-to-lymphocyte ratio as indicator to severe complication after pancreaticoduodenectomy or distal pancreatectomy.

BACKGROUND

Pancreaticoduodenectomy and distal pancreatectomy are complex procedures with high rates of post-operative complications. We evaluated the factors associated with post-operative complications, focusing on pre-operative hematologic markers such as the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index.

METHODS

Data from patients (≥age 20) who underwent pancreaticoduodenectomy or distal pancreatectomy between January 2013 and December 2017 at a Japanese tertiary hospital were retrospectively reviewed. Patients who failed to complete the operation and those who underwent additional procedure were excluded. The primary outcome was reoperation and unplanned intensive care unit admission before first discharge, and secondary outcome was the length of hospital stay. Multivariate analysis was used to identify explanatory factors associated with post-operative complications. The differences in length of hospital stay were compared with the Mann-Whitney U test.

RESULTS

Of 238 eligible patients, 208 with a median age of 71 years were included in the analysis. The median values [1st interquartile range, 3rd interquartile range] of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and prognostic nutritional index were 2.65 [1.69, 4.04], 247 [146, 407], and 46.0 [42.0, 49.7], respectively. Eleven patients (5.3%) experienced post-operative complications. The neutrophil-to-lymphocyte ratio (odds ratio, 1.13; 95% confidence interval, 1.02-1.26; P = 0.03) and blood loss volume (odds ratio per 100 mL, 1.11; 95% confidence interval, 1.00-1.22; P = 0.039) were independently associated with post-operative complications. Post-operative complications contributed to longer hospital stays (19 [15, 28] vs 33 [22, 65] days, P = 0.005).

CONCLUSION

The neutrophil-to-lymphocyte ratio and blood loss volume were significantly associated with post-operative complications, leading to prolonged hospitalization.