Preoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful predictors of 30-day postoperative complications after lumbar fusion
- Department of Surgery, Hull University Teaching Hospitals NHS Trust, Anlaby Road, Hull,
- Department of Health Sciences, University of York, York,
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth Science Park, Plymouth,
- Southwest Neurosurgery Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom.
Temidayo Osunronbi, Department of Surgery, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom.
DOI:10.25259/SNI_160_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Temidayo Osunronbi1,2, Balint Borbas3, Hiba Lusta3, Agbolahan Sofela4, Himanshu Sharma4. Preoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful predictors of 30-day postoperative complications after lumbar fusion. 15-Apr-2022;13:145
How to cite this URL: Temidayo Osunronbi1,2, Balint Borbas3, Hiba Lusta3, Agbolahan Sofela4, Himanshu Sharma4. Preoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful predictors of 30-day postoperative complications after lumbar fusion. 15-Apr-2022;13:145. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=11538
Background: Lymphocyte percentage/count, platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) have shown prognostic significance in patients with cancer, stroke, and following cardiac surgery. However, the utility of these blood parameters for assessing the 30-day postoperative risk for lumbar fusion complications has not been established.
Methods: In this single-center-single-surgeon retrospective series, 77 consecutive patients underwent one- or two-level lumbar fusion. Lymphocyte percentage/count, PLR, and NLR were investigated as predictors of 30-day postoperative complications.
Results: Ten of 77 patients had postoperative complications. A unit increase in NLR and lymphocyte percentage was significantly associated with a 23% increase and 7% decrease, respectively, in the odds of a complication occurring. Preoperative NLR ≥ 2.32 and lymphocyte percentage ≤ 29.5% significantly discriminated between the “complication” and “no-complication” groups.
Conclusion: Patients with a preoperative lymphocyte percentage of ≤29.5% and/or NLR ≥2.32 should be closely monitored as high-risk groups susceptible to 30-day postoperative complications after lumbar fusion.
Keywords: Complications, Lymphocyte, Neutrophil, Prognosis, Spinal fusion
The importance of preadmission/preoperative lymphocyte percentage/count, platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) as prognostic markers following cardiac surgery, stroke, and cancers has been extensively reported.[
In this case–control study, 77 adults underwent elective single- (37 patients) or two-level (40 patients) posterior/posterolateral lumbar fusion performed by one surgeon (2012–2019) [
Statistical analysis was performed on IBM SPSS Statistics 27 (Windows). Binary logistic regression, receiver operating characteristics, and Youden’s index were utilized [
Correlation between 30-day postoperative complications and lymphocyte percentage and NLR
Predictive value of preoperative lymphocyte percentage and NLR for determining 30-day postoperative complications
The area under the curve values for the preoperative NLR and lymphocyte percentage were in the “acceptable” range (0.7–0.8) of prognostic accuracy for postoperative 30-day complications. The optimal cutoff value for preoperative NLR and lymphocyte percentage were ≥2.32 and ≤29.5%, respectively [
We investigated the preoperative predictors of postoperative complications after lumbar fusion. Patients with preoperative lymphocyte percentage ≤29.5% and/or NLR ≥ 2.32 had a higher risk of developing postoperative complications. Other studies have reported similar findings (i.e., high baseline/ preoperative NLR and lymphocytopenia were predictors of worse outcomes).[
A raised NLR (≥2.32) and/or decreased lymphocyte percentage (≤29.5%) at baseline predict the development of postoperative complications after lumbar fusion.
Patient’s consent not required as patients identity is not disclosed or compromised.
There are no conflicts of interest.
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