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

I Wayan Suranadi; Tjokorda Gde Agung Senapathi; Ayu Dilia Febriani  Wisnawa; Christopher Ryalino

doi:10.3889/oamjms.2020.5300

Authors

I Wayan Suranadi Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Bali, Indonesia
Tjokorda Gde Agung Senapathi Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Bali, Indonesia
Ayu Dilia Febriani Wisnawa Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Bali, Indonesia
Christopher Ryalino Department of Anesthesiology and Intensive Care, Faculty of Medicine, Udayana University, Bali, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2020.5300

Keywords:

Neutrophil-to-lymphocyte ratio, Analgesics, Length of stay, Thoracotomy

Abstract

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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