Pre-operative Neutrophil-to-Lymphocyte Ratio is Associated with Post-operative Opioid Requirements and Length of Stay after Thoracotomy

BACKGROUND: Surgical pain and prolonged hospital length of stay (LOS) affect a large proportion of patients after thoracotomy. Inflammation plays a crucial role in the mechanism and progression of pain and the outcomes. AIM: The objective of this study was to investigate the association between the pre-operative neutrophil-to-lymphocyte ratio (NLR) and post-operative pain and LOS in patients undergoing thoracotomy. METHODS: This was a retrospective, observational study on 157 patients who underwent thoracotomy under general anesthesia. We classified the subjects into two study groups: Group with for patients with NLR <2 and Group 2 for NLR ≥2. We measured the post-operative pain by gathering the data of post-operative opioid needs. We used Pearson’s and Spearman’s correlation tests to assess the association of the parameters. RESULTS: The mean of total oral morphine equivalent in the first 48 h following thoracotomy in Group 1 was 140.8 ± 60.4 mg compared to Group 2’s 109.7 ± 55.8 (p < 0.05). The median hospital’s LOS was longer in Group 2 compared to Group 1 (7 vs. 10, p < 0.001). We found a weak positive correlation between pre-operative NLR (R = 0.267, p = 0.002) and post-operative opioid requirements, and a weak positive correlation between pre-operative NLR and the hospital’s LOS (R = 0.345, p < 0.001). CONCLUSION: Pre-operative NLR correlates with post-operative opioid requirements and the time hospital’s LOS in patients who underwent elective thoracotomy.

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The neutrophil to lymphocyte ratio in patients supported with extracorporeal membrane oxygenation

Perfusion ◽

10.1177/0267659118772455 ◽

2018 ◽

Vol 33 (7) ◽

pp. 562-567 ◽

Cited By ~ 3

Author(s):

Gardner Yost ◽

Geetha Bhat ◽

Patroklos Pappas ◽

Antone Tatooles

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Myocardial Damage ◽

Neutrophil Infiltration ◽

Neutrophil To Lymphocyte Ratio ◽

Study Cohort ◽

Lymphocyte Ratio ◽

Membrane Oxygenation ◽

Wide Range ◽

Group 2 ◽

Group 1

Introduction: The neutrophil to lymphocyte ratio (NLR) has proven to be a robust predictor of mortality in a wide range of cardiovascular diseases. This study investigated the predictive value of the NLR in patients supported by extracorporeal membrane oxygenation (ECMO) systems. Methods: This study included 107 patients who underwent ECMO implantation for cardiogenic shock. Median preoperative NLR was used to divide the cohort, with Group 1 NLR <14.2 and Group 2 with NLR ≥14.2. Survival, the primary outcome, was compared between groups. Results: The study cohort was composed of 64 (60%) males with an average age 53.1 ± 14.9 years. Patients in Group 1 had an average NLR of 7.5 ± 3.5 compared to 27.1 ± 19.9 in Group 2. Additionally, those in Group 2 had significantly higher preoperative blood urea nitrogen (BUN) and age. Survival analysis indicated a thirty-day survival of 56.2%, with significantly worsened mortality in patients with NLR greater than 14.2, p=0.047. Discussion: Our study shows the NLR has prognostic value in patients undergoing ECMO implantation. Leukocytes are known contributors to myocardial damage and neutrophil infiltration is associated with damage caused by myocardial ischemia.

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Influence of Body Mass Index on Mechanical Properties in People With Obesity

10.21203/rs.3.rs-383093/v1 ◽

2021 ◽

Author(s):

Serkan Usgu ◽

Engin Ramazanoğlu ◽

Yavuz Yakut

Keyword(s):

Mechanical Properties ◽

Body Mass Index ◽

Body Mass ◽

The Other ◽

Positive Correlation ◽

Weak Positive Correlation ◽

Group 3 ◽

Group 2 ◽

The Right ◽

Group 1

Abstract Background: The study was to determine influence of body mass index on muscular mechanical properties in people with obesity.Methods: A total of 300 individuals (mean age: 27.31±7.21 years) were participated. The participants were assigned in groups base on BMI classification (Group 1 (BMI=18.50-24.99 kg/m2), Group 2 (BMI=25.00-29.99 kg/m2), and Group 3 (BMI≥30 kg/m2)). The biceps brachii (BB), biceps femoris (BF) were measured bilaterally using the "MyotonPRO" device. Results: All mechanical properties of the right and left BB muscle, left BF tone and stiffness were found significantly difference between groups (p<0.05). The bilateral BB tone in Group 3 was lower than the other two groups. The right BB stiffness of Group 2 was found to be higher compared to the other two groups (p<0.05). While the right and left BB elasticity was similar in Groups 2 and 3, it was lower compared to Group 1 (p<0.05). The left BF tone and stiffness of Group 3 were found to be significantly higher than Groups 1 and 2 (p<0.05).The right BB tone showed a weak negative correlation with BMI in females, and for left side in males. A weak positive correlation was found between the right and left BB elasticity and BMI in males and females. The left-right BF tone and left BF stiffness showed a weak positive correlation in males. Conclusions: The bilateral BB tone and elasticity decreased, and the left BF stiffness increased as BMI increased. Different mechanical properties were observed in sex comparasion base on BMI clasification. The BB and BF mechanical properties were affected more in males than females.

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Importance of tranexamic acid in pediatric monosutural craniosynostosis surgery

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.10.peds21438 ◽

2021 ◽

pp. 1-7

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Tranexamic Acid ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Median Volume ◽

Group 3 ◽

Time Periods ◽

Group 2 ◽

Group 1

OBJECTIVE Tranexamic acid (TXA) is an antifibrinolytic drug that has achieved significant reduction in perioperative blood loss and the quantity of blood transfused in many pediatric surgical procedures, without morbidity. Despite the accumulation of evidence regarding its effectiveness in craniosynostosis repair surgery, TXA is not unanimously employed by pediatric neurosurgery teams. The purpose of this study was to evaluate the impact of the routine use of TXA in a homogeneous population of children who underwent open surgery for monosutural craniosynostosis. METHODS The authors retrospectively reviewed 3 cohorts of patients that were subdivided from 2 cohorts surrounding the initiation of TXA (group 1, TXA− [2008–2011] and group 2, TXA+ [2011–2013]) and a third cohort of more recent patients (group 3, TXA+ [2016–2017]). TXA was administered using the same protocol comprising a loading dose of 10 mg/kg over 15 minutes after induction of general anesthesia followed by a 10 mg/kg per hour infusion until skin closure. Patients in all 3 groups underwent similar standardized procedures for scaphocephaly, trigonocephaly, and unicoronal craniosynostosis by the same pediatric neurosurgeon. RESULTS Overall, 102 infants were included in the study: 32 infants in group 1, 36 in group 2, and 34 in group 3. Significant reductions in transfusion of packed erythrocytes (PE) and fresh-frozen plasma (FFP) were observed between the TXA− and TXA+ time periods. The median volume of PE transfusion was reduced by > 50% with the use of TXA (42.8 mL/kg in the TXA− group vs 20.0 in the TXA+ groups, p < 0.0001). Reduction in PE transfusion was 100% postoperatively in the TXA+ groups (20.0 mL/kg in the TXA− group vs 0.0 in the TXA+ groups, p < 0.0001). The median volume of FFP transfusion was reduced by 100% with the use of TXA (12.8 mL/kg in the TXA− group vs 0.0 in the TXA+ groups, p < 0.0001). All children in group 1 received a transfusion, whereas 3 children (8%) and 7 children (20%) in groups 2 and 3, respectively, did not. Significant reductions in postoperative drain output were also noted between the TXA− and TXA+ time periods. The total hospital length of stay was significantly lower in the TXA+ groups (p < 0.0001). CONCLUSIONS Use of TXA reduced blood loss and the need for transfusions but also decreased the hospital length of stay and, thus, minimized overall medical care costs. Intraoperative administration of TXA in craniosynostosis repair surgery should be routinely used in all centers that practice these procedures.

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Could neutrophil-to-lymphocyte ratio be a new mortality predictor value in severe burns?

Journal of Surgery and Surgical Research ◽

10.17352/2455-2968.000063 ◽

2019 ◽

pp. 026-028

Author(s):

Ciftci Ali ◽

Esen Osman ◽

Yazicioglu M Burc ◽

Haksal M Celalettin ◽

Tiryaki Cagri ◽

...

Keyword(s):

Intensive Care ◽

Absolute Lymphocyte Count ◽

Neutrophil To Lymphocyte Ratio ◽

Burn Injuries ◽

Lymphocyte Ratio ◽

Severe Burns ◽

Training And Research ◽

Severe Burn Injuries ◽

Group 2 ◽

Group 1

Background: The aim of our study was to demonstrate if there is any relation between the neutrophil-to-lymphocyte ratio (NLR) and mortality in severe burns Methods: The records of 366 patients who were admitted to Intensive Care Unit of Burn Center of Derince Training and Research Hospital between January 2012 and December 2015 were evaluated retrospectively. The cases who were hospitalized in service or did not require intensive care were not included in the study. The cases were divided into two groups: ex-group (Group 1) and discharge group (Group 2). In both groups demographic information such as age, gender, burn scores, neutrophil counts and lymphocyte counts during admission to the hospital were recorded. NLR is the ratio of absolute neutrophil count to the absolute lymphocyte count. Results: NLR was 10.94±7.63 in the exitus group and 5.5±5.56 in the discharged group. NLR was increased in mortality group and this value was statistically significant (p=0.00). Independent relationship between prognoses and NLR was shown with logistic regression analyses (Odds Ratio 0.895, 95% confidence interval 0.856-0.936, p=0.00). Conclusion: NLR has increased in mortality group. Our study showed that NLR is correlated with probability of mortality after severe burn injuries. Therefore, it can be used as a cheap, easily obtained and new mortality predictor in severe burns.

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Can Peroperative Neutrophil To Lymphocyte Ratio Change (Deltanlr) Be Used as a Parameter in Predicting Acute Renal Failure Following Coronary Bypass Operations With Cardiopulmonary Bypass?

The Heart Surgery Forum ◽

10.1532/hsf.3415 ◽

2021 ◽

Vol 24 (1) ◽

pp. E194-E200

Author(s):

Sefer Usta ◽

Mustafa Abanoz

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Cardiopulmonary Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Coronary Bypass ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Group 2 ◽

Group 1

Background: Inflammation plays a significant role in the pathogenesis of many diseases as well as postoperative acute renal failure (ARF). Preoperative neutrophil to lymphocyte ratio (NLR) values have a prognostic value for postoperative ARF after cardiovascular surgeries. Methods: Patients who underwent elective coronary artery bypass graft (CABG) with cardiopulmonary bypass in our clinic between December 15, 2015 and December 15, 2019, retrospectively were included in this study. Patients who did not develop ARF after the operation were categorized as Group 1, and patients who did were included in Group 2. NLR was calculated from the hemograms during three periods (Preoperative (Pre), Postcardiotomy (Pc), Postoperative Day 1 (Po1). DeltaNLR1 (PcNLR- PreNLR) and DeltaNLR2 (Po1NLR-PreNLR) values were obtained from these calculated values. Results: The mean ages of patients in Group 1 (N = 274) and Group 2 (N = 61) were 60 ± 9.1 years and 67.7 ± 9.8 years, respectively (P < .001). In the multivariate analysis, being over 65 years of age (Odds ratio [OR]: 1.074, 95% confidence interval [CI]: 1.012-1.194, P = .030), postoperative inotropic need (OR: 0.678, CI 95%: 0.395-0.819, P = .021), increased blood product use (OR: 0.916, CI 95%: 0.779-0.986, P = .034), preoperative creatinine increase (OR: 1.974, CI 95%: 1.389-4.224, P = .007), PcNLR (OR : 1.988, CI 95%: 1.765-3.774, P <.001), Po1NLR (OR: 1.090, CI 95%: 1.007-2.116, P = .028), DeltaNLR1 (OR: 3.090, CI 95%: 1.698-6.430, P < .001) and DeltaNLR2 (OR: 1.676, CI 95%: 1.322-2.764, P = .003) were identified as independent predictors for predicting postoperative ARF. Conclusion: In this study, we have shown that peroperative NLR changes can be used as an effective parameter to predict ARF developing following CABG operations.

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Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting

The Heart Surgery Forum ◽

10.1532/hsf.1341 ◽

2015 ◽

Vol 18 (6) ◽

pp. 255 ◽

Cited By ~ 7

Author(s):

Hüseyin Şaşkın ◽

Çagrı Düzyol ◽

Kazım Serhan Özcan ◽

Rezan Aksoy ◽

Mustafa Idiz

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Platelet To Lymphocyte Ratio ◽

Artery Bypass Grafting ◽

Lymphocyte Ratio ◽

Group 2 ◽

Group 1

Objective: To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation. Methods: We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142. Results: The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality. Conclusion: In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

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Management of a pediatric burn center during the covid-19 pandemic

Journal of Burn Care & Research ◽

10.1093/jbcr/irab137 ◽

2021 ◽

Author(s):

Ahmet Erturk ◽

Sabri Demir ◽

Can İhsan Oztorun ◽

Elif Emel Erten ◽

Dogus Guney ◽

...

Keyword(s):

Length Of Stay ◽

Total Body Surface Area ◽

Center Staff ◽

Staff Members ◽

Burn Center ◽

History Of ◽

Group 2 ◽

Travel Abroad ◽

Pcr Test ◽

Group 1

Abstract The aim of this study was to evaluate the results of an algorithm that was created to prevent coronavirus disease-2019 (COVID-19) transmission during the management of children with burns in a tertiary pediatric burn center. Children admitted to the burn center between May 2020 and November 2020 were prospectively evaluated for cause, burn depth, total body surface area (TBSA), length of stay, symptoms suggesting COVID-19, suspicious contact history, history of travel abroad, and COVID-19 polymerase chain reaction (PCR) test results. Patients were divided into two groups: unsuspected (Group 1) and suspected (Group 2), depending on any history of suspicious contact, travel abroad, and/or presence of symptoms. A total of 101 patients were enrolled in the study, which included 59 boys (58.4%) and 42 girls (41.6%). Group 1 included 79 (78.2%) patients, and Group 2 consisted of 22 (21.8%) patients. The most common cause of the burns was scald injuries (74.2%). The mean age, TBSA, and length of stay were 4.5 years, 12.0%, and 13.2 days, respectively. Four patients (3.9%) had a positive PCR test (two patients in each group). Comparing groups, males were more commonly found in Group 2 (p=0.042), but no differences were found for the other variables. No patients or burn center staff members developed COVID-19 during the course of hospitalization. In conclusion, every child should be tested for COVID-19 upon admission to a burn unit, and a modified algorithm should be constructed for the handling and management of pediatric burn patients.

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QUADRATUS LUMBORUM BLOCK IN PATIENTS OF LAPAROSCOPIC CHOLECYSTECTOMY FOR POSTOPERATIVE ANALGESIA

10.36106/gjra/7515425 ◽

2021 ◽

pp. 187-189

Author(s):

Garima Anant ◽

Aman Kaur ◽

Prakriti Prakriti

Keyword(s):

Laparoscopic Cholecystectomy ◽

Study Data ◽

Detailed History ◽

Quadratus Lumborum Block ◽

Post Operative Pain ◽

Quadratus Lumborum ◽

Fentanyl Consumption ◽

Vas Scores ◽

Group 2 ◽

Group 1

Background: Quadratus lumborum block is done ultrasonographically in thoracolumbar fascial plane at the level of quadratus lumborum muscle to decrease post-operative pain in patients who underwent laparoscopic cholecystectomy . Methods: A prospective, randomized and comparative study was conducted in Pt. B.D. Sharma PGIMS, Rohtak. After informed and written consent, patients were recruited in the study and assigned into 2 groups. A detailed history was taken and examination was carried out. Group 1 patients received Inj.. diclofenac IM (intramuscular) 75 mg and in group 2 Bilateral QL (quadratus lumborum) block was given using 15 ml of 0.25 percent levobupivacaine. The results were measured by VAS score and 24hrs fentanyl consumption. At the end of the study, data was compiled and analyzed using SPSS version 17. Results: In the present study, there was no statistical signicant difference between the two groups. We found that the patients who received quadratus lumborum block had lesser fentanyl consumption and the VAS scores were also better.

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Impact of Length of Stay on Functional Outcomes of TBI Patients

The American Surgeon ◽

10.1177/000313480507101105 ◽

2005 ◽

Vol 71 (11) ◽

pp. 920-930 ◽

Cited By ~ 5

Author(s):

M.L. Hawkins ◽

F.D. Lewis ◽

R.S. Medeiros

Keyword(s):

Length Of Stay ◽

Functional Outcomes ◽

Inpatient Care ◽

Average Length ◽

Functional Independence ◽

Average Length Of Stay ◽

Group 2 ◽

The Impact ◽

Group 1

The purpose of this study was to compare the functional outcomes of two groups of patients with traumatic brain injury (TBI) with attention to the impact of reduced length of stay (LOS) in the trauma center (TC) and rehabilitation hospital (RH). From 1991 to 1994, 55 patients, Group 1, with serious TBI (Abbreviated Injury Scale score ≥3) were admitted to a level 1 TC and subsequently transferred to a comprehensive inpatient RH. These results have been previously published. From 1996 to 2002, 64 similarly injured patients, Group 2, received inpatient care at the same TC and RH. These patients had a marked decrease in length of stay. Functional Independence Measures (FIM) were obtained at admission (Adm), discharge (D/C), and at 1 year follow-up for both groups. The average length of stay at the TC dropped from 36 days in Group 1 to 26 days in Group 2. In addition, the average length of stay at the RH dropped from 46 days (Group 1) to 25 days (Group 2); overall, an average reduction of 31 days of inpatient care. Group 2 had significantly lower FIM scores at the time of RH discharge for self-care, locomotion, and mobility compared to Group 1. At the 1 year follow-up, however, there were no significant differences between Groups 1 and 2 in these FIM scores. FIM scores at 1 year were higher in Group 2 for communication (90% vs 71%) and social cognition (77% vs 49%) compared to Group 1. Over one-fourth of each group returned to work by the 1 year follow-up. Socially disruptive behavior occurred at least weekly in 28 per cent (Group 1) and 23 per cent (Group 2) of patients. The outcome for serious TBI is better than generally perceived. Reduction of inpatient LOS did not adversely affect the ultimate functional outcome. The decreased LOS placed a greater demand on outpatient rehabilitative services as well as a greater burden on the family of the brain-injured patient

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The Neutrophil to Lymphocyte Ratio (NLR) Is Associated With Residual Syntax Score in Patients With ST-Segment Elevation Myocardial Infarction

Angiology ◽

10.1177/0003319720958556 ◽

2020 ◽

pp. 000331972095855

Author(s):

Serkan Kahraman ◽

Hicaz Zencirkiran Agus ◽

Yalcin Avci ◽

Nail Guven Serbest ◽

Ahmet Guner ◽

...

Keyword(s):

Myocardial Infarction ◽

Independent Predictor ◽

Syntax Score ◽

St Segment Elevation ◽

Lymphocyte Ratio ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Group 2 ◽

Residual Syntax Score ◽

Group 1

The neutrophil to lymphocyte ratio (NLR) predicts adverse clinical outcomes in several cardiovascular diseases. Our aim was to investigate the association of residual SYNTAX score (rSS) with the NLR in patients (n = 613) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients were divided into 2 groups: group 1 with low NLR (<2.59) and group 2 with high NLR (>2.59). Coronary artery disease severity was calculated for both groups besides baseline clinical and demographic variables. Receiver operating characteristic curve analysis demonstrated that NLR with a cutoff value of 2.59 had good predictive value for increased rSS (area under the curve = 0.707, 95% CI: 0.661-0.752, P < .001). The median rSS value of group 2 was higher (2.0 [0-6.0]; 4.0 [0-10.0], P < .001) compared with group 1; the number of patients with high rSS was also higher in group 2 (26 [9.7%]; 107 [31.0%], P < .001). In multivariate logistic regression analysis, the NLR (odds ratio = 3.933; 95% CI: 2.419-6.393; P < .001) was an independent predictor of high rSS. Additionally, there was a positive correlation between NLR and rSS (r = 0.216, P < .001). In conclusion, higher NLR was an independent predictor of increased rSS in patients with STEMI.

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