Delgado-Miguel Carlos, Muñoz-Serrano Antonio J, Moratilla Lucas, Miguel-Ferrero Miriam, Delgado Bonifacio, Camps Juan, López-Santamaría Manuel, Martínez Leopoldo
Department of Pediatric Surgery, Prisma Health Children's Hospital, Columbia, SC, USA.
Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain.
Transl Pediatr. 2023 Apr 29;12(4):552-559. doi: 10.21037/tp-22-360. Epub 2023 Apr 4.
Surgical site infection (SSI) is one of the most common complications after appendectomy, which carries high associated morbidity. Therefore, it is essential to determine SSI predictive factors in order to prevent its occurrence. The aim of this study is to explore the role of neutrophil-to-lymphocyte ratio (NLR) as a predictor of SSI after appendectomy in children.
A single-center, retrospective cohort study was performed in children who underwent appendectomy between 2017-2020. Demographics, time since symptoms onset, laboratory tests at admission, ultrasound appendiceal diameter, rate of complicated appendicitis, surgical aproach, surgery time and SSI rate were analyzed. Follow-up was performed during hospitalization and at outpatient clinic at 2 weeks and 30 days postoperatively to assess the surgical wound aspect. Diagnostic cut-off values of these markers for SSI prediction were based on the significance in the univariate analysis. Variables with a P value <0.05 in the univariate analysis were then entered into the multivariate analysis.
A total of 1,136 patients (710 males; 426 females) were included. SSI was reported in 53 patients (4.7%) during the 30-day follow-up after appendectomy (SSI group), with no demographic differences with the control group. Time since symptoms onset was significantly higher in SSI group (24 18 hours; P=0.034), as well as ultrasound appendiceal diameter (10.5 8.5 mm; P=0.010). Complicated appendicitis was observed in about 60% of both groups, without differences in surgical approach between them. Surgery time was statistically higher in the SSI group (62.4 47.9 min; P<0.001). SSI group presented higher counts of leukocytes, neutrophils and NLR than control group (P<0.001). NLR was the parameter with the highest area under the curve (AUC) (AUC =0.808; P<0.001), with a cut-off point of 9.8 with maximum sensitivity (77.8%) and specificity (72.7%). NLR was an independent predictive factor for SSI in the multivariate analysis [odds ratio (OR) 1.82 (1.13-2.73); P<0.01].
NLR value at admission was the most promising predictive factor for the development of SSI in children undergoing appendectomy. It is an easy, simple, inexpensive, and rapid method to detect patients at high risk for SSI. However, further prospective studies are still needed to confirm these results.
手术部位感染（SSI）是阑尾切除术后最常见的并发症之一，其相关发病率很高。因此，确定SSI的预测因素对于预防其发生至关重要。本研究的目的是探讨中性粒细胞与淋巴细胞比值（NLR）作为儿童阑尾切除术后SSI预测指标的作用。
对2017年至2020年间接受阑尾切除术的儿童进行了一项单中心回顾性队列研究。分析了人口统计学资料、症状出现后的时间、入院时的实验室检查、超声阑尾直径、复杂性阑尾炎发生率、手术方式、手术时间和SSI发生率。在住院期间以及术后2周和30天的门诊进行随访，以评估手术伤口情况。这些指标用于SSI预测的诊断临界值基于单因素分析中的显著性。单因素分析中P值<0.05的变量随后进入多因素分析。
共纳入1136例患者（710例男性；426例女性）。在阑尾切除术后30天的随访中，53例患者（4.7%）报告发生了SSI（SSI组），与对照组在人口统计学上无差异。SSI组症状出现后的时间显著更长（24±18小时；P=0.034），超声阑尾直径也更大（10.5±8.5mm；P=0.010）。两组中约60%观察到复杂性阑尾炎，两组手术方式无差异。SSI组的手术时间在统计学上更长（62.4±47.9分钟；P<0.001）。SSI组的白细胞、中性粒细胞计数和NLR均高于对照组（P<（此处原文有误，应为P<0.001））。NLR是曲线下面积（AUC）最高的参数（AUC=0.808；P<0.001），临界值为9.8时具有最大敏感性（77.8%）和特异性（72.7%）。在多因素分析中，NLR是SSI的独立预测因素[比值比（OR）1.82（1.13 - 2.73）；P<0.01]。
入院时的NLR值是接受阑尾切除术儿童发生SSI最有前景的预测因素。它是一种检测SSI高危患者的简便、易行、廉价且快速的方法。然而，仍需要进一步的前瞻性研究来证实这些结果。
