The Utility of Neutrophil-to-Lymphocyte Ratio as a Severity Predictor of Acute Appendicitis, Length of Hospital Stay and Postoperative Complication Rates

Abstract Background The acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. Methods This single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.Results In total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).Conclusions Since the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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Neutrophil to lymphocyte ratio (NLR) in acute pancreatitis as an early predictor of severity and outcome

International Surgery Journal ◽

10.18203/2349-2902.isj20184619 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3545

Author(s):

Noor Mohammed Shawnas Bhanou ◽

Gayatri Balachandran ◽

Nisha B. Jain

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Organ Failure ◽

Length Of Hospital Stay ◽

Adverse Outcomes ◽

Neutrophil To Lymphocyte Ratio ◽

Initial Time ◽

Lymphocyte Ratio ◽

Icu Admission ◽

Marshall Score

Background: The management of Acute Pancreatitis (AP) is determined by an accurate assessment of severity of the disease. Numerous severity indicators have been described till date, most of which require reassessment after admission and resuscitation. We propose a novel indicator, the Neutrophil to Lymphocyte ratio (NLR), as a predictor of severity of acute pancreatitis at the initial time of diagnosis. NLR may have a role in predicting the length of hospital stay and ICU admission and also to predict adverse manifestations of Severe Acute Pancreatitis (SAP) including organ failure.Methods: A retrospective analysis was performed of 107 patients diagnosed with acute pancreatitis based on Atlanta 2012 definitions, who were admitted and treated between August 2017 and November 2017. The patients were grouped according to severity of acute pancreatitis and organ failure occurrence and a comparative analysis was performed to compare the NLR between groups. NLR was also compared with the modified Marshall score as a standard predictor of organ failure in acute pancreatitis.Results: Median NLR among the severe group is significantly higher compared to mild and moderate group (P <0.001). NLR significantly correlated with length of hospital stay (p 0.004) and also had a statistically significant correlation with ICU stay (p < 0.001). We found in our study that NLR at admission correlated significantly with the modified Marshall score in predicting the organ failure (p <0.001) in patients with acute pancreatitis. The receiver operator characteristic (ROC) curve analysis showed a cut-off values of NLR >8.5 at admission correlated with adverse outcomes in patients with acute pancreatitis.Conclusions: Neutrophil to Lymphocyte ratio (NLR) can be used as a predictor of severity of acute pancreatitis, right at the time of initial diagnosis. Further it may predict adverse outcomes, need for ICU care as well as length of hospital stay. NLR can be used as a tool to refer at risk patients to tertiary center needing ICU admission.

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Does Neutrophil to Lymphocyte Ratio Predict Hospital Stay in Appendectomy Patients?

International Surgery ◽

10.9738/intsurg-d-15-00249.1 ◽

2016 ◽

Vol 101 (5-6) ◽

pp. 222-226 ◽

Cited By ~ 1

Author(s):

Zulfu Bayhan ◽

Sezgin Zeren ◽

Ertugrul Kargi ◽

Faik Yaylak ◽

Mehmet Korkmaz ◽

...

Keyword(s):

Hospital Stay ◽

Ct Scan ◽

Length Of Hospital Stay ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Postoperative Length ◽

Pathology Reports ◽

The Impact ◽

The Relationship ◽

Histopathologic Findings

We aimed to investigate the relationship between neutrophil to lymphocyte ratio (NLR) and the postoperative length of hospital stay. In addition, the impact of radiologic and histopathologic findings on hospital stay was also evaluated. This was a retrospective study; 103 patients with appendicitis were included. Diagnosis was confirmed with computerized tomography (CT) scans, ultrasonography, and histopathologic examination. Correlations between the length of hospital stay and age; sex; NLR; c-reactive peptide (CRP) levels; appendix diameter on CT scan or ultrasonography; appendix localization; and pathology reports were evaluated. The length of hospital stay was not related to age or sex. The length of hospital stay after appendectomy was correlated with appendix diameter on CT scan and phlegmonous appendicitis, but it was not associated with NLR, CRP levels, or appendix diameter on ultrasonography. This is a pioneer study, given there is no comprehensive study to date evaluating the association between NLR levels and the length of hospital stay of patients with acute appendicitis. NLR is not associated with the length of hospital stay. Appendix diameter with CT scan and appendix pathology reports are correlated with the length of postoperative hospital stay in appendectomy patients.

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816 Managing Acute Appendicitis During the First Wave of the COVID-19 Pandemic: A Single-Centre Retrospective Study

British Journal of Surgery ◽

10.1093/bjs/znab259.478 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

A Lotfallah ◽

A Aamery ◽

G Moussa

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Statistical Significance ◽

Length Of Hospital Stay ◽

Interquartile Range ◽

Secondary Outcome ◽

Complication Rates ◽

Alvarado Score ◽

Significant Difference

Abstract Introduction The COVID-19 pandemic provoked a change to normal surgical practice and led to a higher proportion of acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse patients presenting with AA during the first wave of the pandemic, comparing surgically and conservatively managed patients. Method All patients presenting to our centre with AA between March and July 2020 were included. Six-month follow-up data was collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcome was length of hospital stay. Results Fifty-seven patients (n = 57) were admitted with AA, 45.6% (n = 26) managed conservatively compared to 54.4% (n = 31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not statistically significant (16% vs 35%; p = 0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p = 0.012 and p = 0.028 respectively). Conclusions Stratification criteria, such as Alvarado score and WCC may identify patients more suitable for conservative management. Longer term follow-up will be carried out, which may alter complication rates in either group. We suggest all patients treated conservatively should undergo computerised tomography (CT) to exclude complicated appendicitis. Further UK-based studies will add to the evidence-base surrounding management of AA during the COVID-19 pandemic.

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Characteristics and Outcomes of Acute Appendicitis Cases During the COVID-19 Pandemic

10.21203/rs.3.rs-94523/v1 ◽

2020 ◽

Author(s):

Murat Başer ◽

Mehmet Kağan Katar

Keyword(s):

Acute Appendicitis ◽

Hospital Stay ◽

Open Surgery ◽

Open Appendectomy ◽

Length Of Hospital Stay ◽

Operation Time ◽

Complication Rates ◽

Duration Of Symptoms ◽

Conversion To Open Surgery ◽

Group B

Abstract Background: Our aim in this study was to investigate the effects of the COVID-19 pandemic on acute appendicitis cases.Methods: This study was designed as a single-center, retrospective, and observational study. The patients were divided into three groups relative to the date of the first COVID-19 case in Turkey, which was March 10, 2020 (Group A: before the pandemic; Group B: pandemic period; Group C: the same period one year before the pandemic). A total of 413 patients were included in the study.Results: In terms of treatment modality, the rate of open appendectomy was significantly higher in group B (p<0.001). Rates of conversion to open surgery, as well as rates of complicated appendicitis were also significantly higher in group B (p=0.027, p=0.024, respectively). While there was no difference between the groups in terms of preoperative hospitalization duration (p=0.102), it was found that the duration of symptoms, operation time, and postoperative length of hospital stay were significantly higher in Group B (p<0.001, p=0.011, p=0.001, respectively). In addition, the complication rate in group B (8.9%) was also significantly higher than in the other two groups (p=0.023).Conclusion: We found that the rate of open surgery, the rate of conversion of laparoscopic surgery to open surgery, complication rates, mean operation time, and postoperative hospital stay were significantly higher in acute appendicitis patients that underwent surgery during the COVID-19 pandemic period. We believe that the main reason for this negative outcome is the late admission of the patients to the hospital.

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Impact of an Acute Care Surgery Model on the Management of Acute Appendicitis in South Korea: A Retrospective Cohort Study

Emergency Medicine International ◽

10.1155/2021/5522523 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Background. The acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. Methods. This single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann–Whitney U-test were used for continuous and nonnormally distributed data, respectively. Results. In total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3 ± 3.2 days vs. 7.2 ± 9.6 days, p = 0.039 ). Conclusions. Since the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.

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Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

10.21203/rs.3.rs-111093/v3 ◽

2021 ◽

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Abstract BackgroundThe acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea.MethodsThis single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.ResultsIn total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).ConclusionsSince the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio predict length of hospital stay in myocarditis

Scientific Reports ◽

10.1038/s41598-021-97678-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Moritz Mirna ◽

Lukas Schmutzler ◽

Albert Topf ◽

Uta C. Hoppe ◽

Michael Lichtenauer

Keyword(s):

Hospital Stay ◽

Leukocyte Count ◽

Systolic Function ◽

Length Of Hospital Stay ◽

Neutrophil To Lymphocyte Ratio ◽

Laboratory Parameters ◽

Lymphocyte Ratio ◽

Lv Systolic Function ◽

Prolonged Hospital ◽

Study Laboratory

AbstractNeutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with the severity of various diseases. The aim of this study was to demonstrate the relationship of NLR and MLR with the severity of myocarditis. 202 consecutive patients with myocarditis were retrospectively enrolled in this study. Laboratory parameters and clinical data were extracted from hospital records and discharge letters. Median NLR was 2.48 (IQR 1.55–4.58) and median MLR was 0.42 (IQR 0.39–0.58). NLR and MLR correlated with HF, CRP and leukocyte count, MLR further correlated inversely with LV systolic function (rs = − 0.379, p = 0.030). Both ratios correlated better with length of hospital stay (NLR: rs = 0.435, p = 0.003; MLR: rs = 0.534, p < 0.0001) than CRP, leukocyte count, IL-6 or procalcitonin. AUCs for the prediction of prolonged hospital stay (NLR = 0.75, MLR = 0.80), and optimal cut-offs therefor were calculated. Patients who had in-hospital complications showed a higher NLR, however, this remained statistically insignificant. NLR and MLR correlated with the length of stay, as well as with several clinical and laboratory parameters in patients with myocarditis. Since white blood cell differentials are relatively easy and fast to perform, both ratios could facilitate further risk stratification in affected patients.

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Impact of an acute Care Surgery Model on the Management of acute Appendicitis in South Korea: A Retrospective Cohort Study

10.21203/rs.3.rs-111093/v1 ◽

2020 ◽

Author(s):

Gun-Hee Yi ◽

Hak-Jae Lee ◽

Seul Lee ◽

Jong-Hee Yoon ◽

Suk-Kyung Hong

Keyword(s):

Acute Appendicitis ◽

South Korea ◽

Hospital Stay ◽

Acute Care ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Acute Care Surgery ◽

Medical Procedure ◽

Complication Rates ◽

Care Surgery

Abstract BackgroundThe acute care surgery (ACS) system is a new model for the prompt management of diseases that require rapid treatment in patients with acute abdomen. This study compared the outcomes and characteristics of the ACS system and traditional on-call system (TROS) for acute appendicitis in South Korea. MethodsThis single-center, retrospective study included all patients (aged ≥18 years) who underwent surgery for acute appendicitis in 2016 and 2018. The TROS and ACS system were used for the 2016 and 2018 groups, respectively. We retrospectively obtained data on each patient from the electrical medical records. The independent samples t-test and Mann-Whitney U-test were used for continuous and non-normally distributed data, respectively.ResultsIn total, 126 patients were included. The time taken to get from the emergency room admission to the operating room, operation times, and postoperative complication rates were similar between both groups. However, the length of the hospital stay was shorter in the ACS group than in the TROS group (4.3±3.2 days vs. 7.2±9.6 days, p=0.039).ConclusionsSince the introduction of the ACS system, the length of hospital stay for surgical patients has decreased. This may be due to the application of an integrated medical procedure, such as a new clinical pathway, rather than differences in the surgical techniques.Trial registration: Retrospectively registered.

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