Affiliation:
1. Department of General Surgery. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines” Instituto Mexicano del Seguro Social (IMSS) Veracruz Mexico
2. Department of Research. Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines” Instituto Mexicano del Seguro Social (IMSS) Veracruz Mexico
Abstract
AbstractBackgroundBile duct injury (BDI) repair surgery is usually associated with morbidity/mortality. The neutrophil‐to‐lymphocyte ratio (NLR) easily assesses a patient's inflammatory status. The study aims to determine the possible relationship between preoperative NLR (pNLR) with postoperative outcomes in BDI repair surgery.MethodsApproved Ethics/Research Committee retrospective study, in patients who had a Bismuth‐Strasberg type E BDI repair (2008–2023). Data registered was: morbidity, mortality, and long‐term outcomes (primary patency and loss of primary patency) (Kaplan–Meier). Group comparison (U Mann–Whitney), receiver operator characteristic (ROC): area under curve [AUC]; cut‐off value, and Youden index [J], and logistic regression analysis were used for pNLR evaluation.ResultsSeventy‐three patients were studied. Mean age was 44.4 years. E2 was the commonest BDI (38.4%). Perioperative morbidity/mortality was 31.5% and 1.4%. Primary patency was 95.9%. 8.2% have lost primary patency (3‐year actuarial patency: 85.3%). Median pNLR was higher in patients who had any complication (4.84 vs. 2.89 p = 0.015), biliary complications (5.29 vs. 2.86 p = 0.01), and patients with loss of primary patency (5.22 vs. 3.1 p = 0.08). AUC's, cut‐off values and (J) were: any complication (0.678, pNLR = 4.3, J = 0.38, p = 0.007), serious complication (0.667, pNLR = 4.3, J = 0.34, p = 0.04), biliary complications (0.712, pNLR = 3.64, J = 0.46, p = 0.001), and loss of primary patency (0.716, pNLR = 3.24, J = 0.52, p = 0.008). Logistic regression was significant in any complication (Exp [B]: 0.1, p = 0.002), serious complications (Exp [B]: 0.2, p = 0.03), and biliary complications (Exp [B]: 8.1, p = 0.003).ConclusionspNLR is associated with complications in BDI repair with moderate to acceptable predictive capacity. pNLR could potentially predict patency of a BDI repair.