EGS P14 Can preoperative Neutrophil-lymphocyte ratio predict post-operative complications in appendicectomy?


 
 
 Complications after appendicectomy remain common. Neutrophil-lymphocyte ratio (NLR) measures inflammation by incorporating the innate and adaptive components of the circulating immune system. We hypothesised that pre-operative NLR could predict post-operative complications after emergency appendicectomy.
 
 
 
 A multicentre retrospective observational study was performed investigating all adults undergoing emergency appendicectomy across four hospital (2 teaching centres and 2 district general hospitals) between August 2018 and November 2020. Patients were identified through pathology records. Electronic records were studied for patient demographics, pre-operative routine laboratory tests, imaging, operative details, and post-operative complications. Neutrophil-lymphocyte ratio was calculated by dividing the pre-operative neutrophil count value by the lymphocyte value. A threshold of 8 was used based on previous literature.
 
 
 
 There were 1130 patients identified who underwent emergency appendicectomy, with 43.6% female. ASA level was I or II in 93.8% of patients, and 82.3% underwent a laparoscopic approach. Perforated appendicitis was observed in 21.7% of patients and two patients died. Mean NLR was 10.3 (SD 8.2), with 50.9% of patients with an NLR of >8. NLR >8 was associated with deep surgical site infections (SSI) (p < 0.001). NLR > 8 was predictive of deep SSI with an odds ratio of 3.455 (CI 1.840–6.488, p < 0.001).
 
 
 
 The NLR is an easy to calculate parameter which, when higher than 8, predicts deep surgical site infection following emergency appendicectomy and may help guide perioperative decision making such as antibiotic duration.
