Postoperative lymphocyte percentage and neutrophil–lymphocyte ratio are useful markers for the early prediction of surgical site infection in spinal decompression surgery

Abstract

Purpose: Although the neutrophil–lymphocyte ratio (NLR) is a simple biomarker for inflammation, its diagnostic value for predicting surgical site infection (SSI) after spinal decompression surgery has not been extensively investigated. We aimed to determine the predictive value of NLR for SSI in patients undergoing spinal decompression surgery. Methods: We performed a retrospective observational study of patients who underwent spinal decompression surgery. Consecutive 254 patients were divided into an SSI group and a non-SSI group based on the presence of SSI. We evaluated which markers, including NLR, differed significantly between groups. We then determined the diagnostic cutoff values of these markers for the prediction of SSI based on the significance in the univariate analysis. Results: The incidence of SSI was 7 of 254 patients (2.8%). Univariate analysis showed that there were significant differences in the C-reactive protein (CRP) level at 1 day postoperatively; neutrophil and lymphocyte percentage and NLR at 3–4 days postoperatively; and CRP level, white blood cell count, neutrophil count and percentage, lymphocyte percentage, and NLR at 6–7 days postoperatively between SSI and non-SSI groups. Among these markers, the cutoff values of lymphocyte percentage and NLR at 3–4 days postoperatively for the prediction of SSI were ≤15.1% and ≥4.91, respectively. The cutoff values of lymphocyte percentage and NLR at 6–7 days postoperatively were ≤19.8% and ≥3.21, respectively. Conclusions: Lymphocyte percentage and NLR at 3–4 and 6–7 days postoperatively were useful markers for the early prediction of SSI in patients who had undergone spinal decompression surgery. These parameters may aid in identifying patients at higher risk of SSI after spinal decompression surgery.

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“…Thus, increased NLR is considered a possible sign of contamination 24,25 . Indeed, similar to our findings, the increase in NLR detected after some surgical operations have been reported as a useful marker for detecting postoperative infections 26,27 . These factors are similar to and suggestive of the possible factors previously reported.…”

Effects of Perioperative Inflammatory Response in Cervical Cancer: Laparoscopic versus Open Surgery

“…In this study, the small increase in NLR in laparoscopic surgery compared to open surgery is thought to be due to minimal incision and surgical manipulation, and this is associated with rapid recovery, low incidence of surgical site infections, and short hospital stay [ 27 , 28 , 29 ]. These results are consistent with a study that reported that laparoscopic surgery had less postoperative inflammatory responses than open surgery [ 30 ].…”

Changes in Invasiveness and Latent Infection Rate Associated with Switching the Approach in Total Hip Replacement

“… 21 - 23 Furthermore, it has been actively reported recently that the percentage of lymphocyte to total WBC count or the ratio of lymphocyte to neutrophils indicate latent infection. 24 - 26 We therefore defined the latent infection as those satisfying either cases with lymphocyte count <1000/μL or cases comprising <10% of the total WBC count around postoperative day 4, and investigated how many such latent infection cases existed and whether any change in the proportion of such cases occurred with the approach change; that is, whether the latent infection rate changed. Specifically, postoperative white blood cell count and postoperative lymphocyte count were measured and compared before and after the change in approach.…”