Association between preoperative neutrophil-to-lymphocyte ratio and length of stay in pediatric patients undergoing laparoscopic appendectomy: a retrospective cohort study.

BACKGROUND

Although the neutrophil-to-lymphocyte ratio (NLR) has demonstrated diagnostic utility in appendicitis, its predictive value for postoperative recovery outcomes remains uncertain. This investigation sought to examine the association between preoperative NLR and length of stay (LOS) in pediatric patients who underwent laparoscopic appendectomy.

METHODS

We performed a retrospective analysis of 815 pediatric patients (aged < 18 years) who underwent laparoscopic appendectomy between January 2021 and December 2022 at Suining Central Hospital. The primary exposure variable was preoperative NLR, with postoperative LOS serving as the main outcome measure. Multiple regression models were established, with adjustments for demographic characteristics, clinical parameters, and surgical variables.

RESULTS

Following comprehensive adjustment, each 10-unit increment in NLR was associated with a 0.19-day prolongation in LOS (95% CI: 0.02, 0.36; P = 0.025). Stratified analyses demonstrated significant positive correlations in male patients, cases without appendiceal fecalith, patients without drainage tubes, and those with uncomplicated appendicitis (all P < 0.05). Smooth curve analysis revealed a consistent positive association between NLR and LOS throughout the entire spectrum of NLR values.

CONCLUSION

Preoperative NLR demonstrated a positive association with postoperative LOS in pediatric patients undergoing laparoscopic appendectomy, indicating its potential value as a predictive marker for hospital resource utilization and perioperative management optimization.