Association of Hematologic Parameters with Post-operative Outcomes in Patients Undergoing Lumbar Disc Herniation Surgery Hematological parameters on lumbar disc surgery
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Abstract
Objective: In this study, we aimed to determine whether hematologic parameters have an effect on the post-operative outcomes in patients operated for lumbar disc herniation.
Material and Methods: The study was conducted in the retrospective cohort design in the Department of Neurosurgery of Ankara Güven Hospital and included patients who were hospitalized and treated with the diagnosis of Lumbar Disc Herniation (LDH) between 01.01.2019 and 31.12.2020. Patients' pre-operative hematologic parameters, which were routinely studied preoperatively, and Visual Analogue Scale (VAS) scoring records, which were routinely used to monitor pain levels, were retrospectively reviewed, and the outpatient clinic notes of the patients within 6 months post-operatively were evaluated.
Results: Among 117 patients hospitalized with LDH over a 1-year period, 87 patients were included in the study. 30 LDH patients, owning factors that may affect wound healing and platelet function (active infection/diabetes mellitus, antiaggregants/anticoagulants) were excluded. When Hb was examined from the pre-operative hematological parameters, anemia was detected in 6 (7%) of 87 patients; however, it had no significant effects on VAS scores and surgical outcomes (p>0.05). Pre-operative Neutrophil-to-Lymphocyte Ratio (NLR) was elevated in 17 (20%) of the 87 patients, and the VAS score of these patients was found to be 1.5-fold higher than normal patients (p=0.031). Post-operative complications (infection, hemorrhage and cerebrospinal fluid fistula) were detected in 5 (6%) of the 87 patients who underwent surgery, and it was found that the pre-operative NLR values were high in these 5 patients. It was also found that high NLR increased the risk of post-operative complications 1.4-fold in patients (p=0.002). No results could be obtained regarding the platelet values because this parameter was within the normal range preoperatively in all patients.
Conclusion: In the present study, the effects of hematological parameters on lumbar disc surgery were investigated, and it was concluded that elevated NLR values increased wound site infection among post-operative complications and VAS scores.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2023-08-22
Published 2023-08-24
References
Grotle M, Småstuen MC, Fjeld O, Grøvle L, Helgeland J, Storheim K, vd. Lumbar spine surgery across 15 years: trends, complications and reoperations in a longitudinal observational study from Norway. BMJ Open. 2019;9(8):e028743.
Todd AG. Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med. 2011;4(4):168-74.
Hennrikus E, Ou G, Kinney B, Lehman E, Grunfeld R, Wieler J, vd. Prevalence, Timing, Causes, and Outcomes of Hyponatremia in Hospitalized Orthopaedic Surgery Patients. J Bone Joint Surg Am. 2015;97(22):1824-32.
Phan K, Wang N, Kim JS, Kothari P, Lee NJ, Xu J, vd. Effect of Preoperative Anemia on the Outcomes of Anterior Cervical Discectomy and Fusion. Glob Spine J. 2017;7(5):441-7.
Cappellini MD, Motta I. Anemia in Clinical Practice-Definition and Classification: Does Hemoglobin Change With Aging? Semin Hematol. 2015;52(4):261-9.
Purvis TE, Goodwin CR, Molina CA, Frank SM, Sciubba DM. Percentage change in hemoglobin level and morbidity in spine surgery patients. J Neurosurg Spine. 2018;28(3):345-51.
Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
Gomes Dos Santos A, de Carvalho RF, de Morais ANLR, Silva TM, Baylão VMR, Azevedo M, vd. Role of neutrophil-lymphocyte ratio as a predictive factor of glioma tumor grade: A systematic review. Crit Rev Oncol Hematol. 2021;163:103372.
Li W, Hou M, Ding Z, Liu X, Shao Y, Li X. Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Stroke: A Systematic Review and Meta-Analysis. Front Neurol. 2021;686-983
Russell CD, Parajuli A, Gale HJ, Bulteel NS, Schuetz P, de Jager CPC, vd. The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis. J Infect. 2019;78(5):339-48.
Bronheim RS, Oermann EK, Cho SK, Caridi JM. Coagulation Profile as a Risk Factor for 30-day Morbidity Following Cervical Laminectomy and Fusion. Spine. 2018;43(4):239-47.
Chang CC, Chang HC, Wu CH, Chang CY, Liao CC, Chen TL. Adverse postoperative outcomes in surgical patients with immune thrombocytopenia. Br J Surg. 2013;100(5):684-92; discussion 693.
Yann-Alexandre Vano , Stéphane Oudard , Marie-Agnès By , Pauline Têtu 1 2, Constance Thibault Hail Aboudagga Florian Scotté Reza Elaidi . Optimal cut-off for neutrophil-to-lymphocyte ratio: Fact or Fantasy? A prospective cohort study in metastatic cancer patients. VANO, Yann-Alexandre, et al. Optimal cut-off for neutrophil-to-lymphocyte ratio: Fact or Fantasy? A prospective cohort study in metastatic cancer patients. PloS one. 2018;13.4: e0195042.
Malpani R, Gala RJ, Adrados M, Galivanche AR, Clark MG, Mercier MR, vd. High, As Well As Low, Pre-operative Platelet Counts Correlate With Adverse Outcomes After Elective Posterior Lumbar Surgery. Spine. 2020;45(5):349-56.
Chow JH, Chancer Z, Mazzeffi MA, McNeil JS, Sokolow MJ, Gaines TM, vd. Impact of Pre-operative Platelet Count on Bleeding Risk and Allogeneic Transfusion in Multilevel Spine Surgery. Spine. 2021;46(1):E65-72.
Aynaszyan S, Udoeyo IF, DelSole EM. The effect of low pre-operative platelet count on adverse outcomes following lumbar microdiscectomy. North Am Spine Soc J NASSJ. 2022;10:100-116.
Suresh KV, Wang K, Sethi I, Zhang B, Margalit A, Puvanesarajah V, vd. Spine Surgery and Pre-operative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review. Glob Spine J. 2022;12(1):155-65.
Cai Q, Zeng S, Zhi L, Wu J, Ma W. Predictors of haematocrit in lumbar fusion for lumbar disc herniation: a surgical assessment. BMC Musculoskelet Disord. 2017;18(1):323.
Kakhki RD, Dehghanei M, ArefNezhad R, Motedayyen H. The Predicting Role of Neutrophil- Lymphocyte Ratio in Patients with Acute Ischemic and Hemorrhagic Stroke. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc. 2020;29(11):105-233.
Diem S, Schmid S, Krapf M, Flatz L, Born D, Jochum W, vd. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer Amst Neth. 2017;111:176-81.
Manuel V, Miana LA, Guerreiro GP, Tenório DF, Turquetto A, Penha JG, vd. Prognostic value of the pre-operative neutrophil-lymphocyte ratio in patients undergoing the bidirectional Glenn procedure. J Card Surg. 2020;35(2):328-34.
Manuel V, Miana LA, Turquetto A, Guerreiro GP, Fernandes N, Jatene MB. The role of the neutrophil-lymphocyte ratio for pre-operative risk stratification of acute kidney injury after tetralogy of Fallot repair. Cardiol Young. 2021;31(6):1009-14.
Shen CJ, Miao T, Wang ZF, Li ZF, Huang LQ, Chen TT, vd. Predictive value of post-operative neutrophil/lymphocyte count ratio for surgical site infection in patients following posterior lumbar spinal surgery. Int Immunopharmacol. 2019;74:105705.
Inose H, Kobayashi Y, Yuasa M, Hirai T, Yoshii T, Okawa A. Postoperative lymphocyte percentage and neutrophil-lymphocyte ratio are useful markers for the early prediction of surgical site infection in spinal decompression surgery. J Orthop Surg Hong Kong. 2020;28(2):2309499020918402.
He J, Bian X, Song C, Zhang R, Yuan S, Yin D, vd. High neutrophil to lymphocyte ratio with type 2 diabetes mellitus predicts poor prognosis in patients undergoing percutaneous coronary intervention: a large-scale cohort study. Cardiovasc Diabetol. 2022;21(1):156.
Sung HM, Lee SH, Oh AR, Kim S, Kim J, Gook J, vd. Association between pre-operative neutrophil-lymphocyte ratio and mortality after plastic and reconstructive surgery. Sci Rep.2021;11(1):21541.
Zhu Y, Bi Y, Liu B, Zhu T. Assessment of prognostic value of pre-operative neutrophil-to-lymphocyte ratio for postoperative mortality and morbidity. Front Med. 2023;10:1102733.