Pre-Operative Neutrophil-Lymphocyte Ratio to Predict Outcomes in Elective Laparoscopic Cholecystectomy

Background: Many scoring systems exist to predict operative difculty and outcomes of laparoscopic cholecystectomy in acute cholecystitis. In elective laparoscopy where ambulatory/ outpatient surgery is considered, few studies are available. Neutrophil-lymphocyte ratio (NLR) can be used as an effective pre-operative predictive marker in elective laparoscopic cholecystectomy. A single center prospective observational study was done over a period of one year Materials and Methods: in 72 patients undergoing elective laparoscopic cholecystectomy. Only those patients with predicted easy/ moderate laparoscopic cholecystectomy were included. NLR ≥ 3 was considered high. Intraoperative and postoperative outcomes were studied in normal and high NLR patients. Results: Normal neutrophil-lymphocyte ratio (NLR) was noted in 46 patients (63.9%) and high NLR (≥ 3) in 26 patients (36.1%). Rates of previous cholecystitis/ cholangitis and ERCP with stenting were similar in both groups. Mean G10 intra-operative score was 1.98 (easy group) in normal NLR group vs 3 (moderate group) in high NLR group (p <0.05). None of the patients who participated in the study needed conversion to open procedure or had adverse intra-operative outcomes. Post-operatively, patients with normal NLR had signicantly low pain score at day 1 compared to high NLR group (1.91 vs 4.5; p <0.001). Patients with high NLR also had signicantly increased length of hospital stay (1.19 days in normal NLR vs 2.77 days in high NLR, p <0.001). Positive predictive value (PPV) of high NLR in estimating hospitalization post-surgery of more than 1 day is 92.3%. Pre-operative NLR can be used as a cost-effective and useful tool in pred Conclusion: icting outcomes in elective laparoscopic cholecystectomy, even in carefully selected group of patients. In settings of outpatient cholecystectomy, this will help in decision making and patient selection.