ABSTRACT Background Surgical site infection (SSI) is a major complication after ileal pouch–anal anastomosis (IPAA) in pediatric ulcerative colitis (UC), significantly impairing quality of life. The lymphocyte‐to–C‐reactive protein ratio (LCR), a composite marker of systemic inflammation and immune/nutritional status, has emerged as a potential predictor of postoperative outcomes. This study assessed the utility of preoperative LCR in predicting SSI in pediatric UC. Methods We retrospectively reviewed pediatric UC patients who underwent IPAA at Mie University Hospital between 2000 and 2024. Preoperative LCR values were analyzed, and the optimal cutoff for SSI prediction was determined using receiver operating characteristic (ROC) analysis. Multivariate logistic regression was performed to identify independent risk factors. SSI was defined according to CDC criteria within 30 days postoperatively. Results Among 57 patients, 11 (19.3%) developed SSI. The incidence was higher in three‐stage procedures than in two‐stage procedures (22.7% vs. 17.1%). In both groups, preoperative LCR was significantly lower in SSI‐positive patients. ROC analysis demonstrated good discrimination (AUC: 0.80), with an optimal cutoff of LCR < 5000 (sensitivity: 90.9%, specificity: 71.7%). Multivariate analysis confirmed LCR < 5000 as an independent predictor of SSI (odds ratio OR: 6.34, 95% CI: 1.23–48.2, p = 0.027). Conclusion Preoperative LCR is a simple, objective biomarker that reliably predicts SSI risk in pediatric UC patients undergoing IPAA. Incorporating LCR into preoperative risk stratification may enable personalized interventions, including nutritional optimization and tailored prophylaxis, to improve surgical outcomes.
Koike et al. (2026) studied this question.