Abstract
OBJECTIVES: Blood-derived immune-inflammatory markers have been identified as promising tools in many conditions. This study aims to determine the perioperative factors and hematologic indices associated with the occurrence of delayed recover after pancreatic and biliary surgeries (PBS). METHODS: Included in this study were 106 patients with PBS who were divided into prolonged hospitalization group (≤5 days; n = 48) and short hospitalization group (>5 days; n = 58) between January 2020 and April 2023 in a tertiary hospital in Saudi Arabia. The clinico-demographic characteristics, laboratory parameters and blood-derived immune-inflammatory markers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), aggregate index of systemic inflammation, and systemic inflammatory response index) of the patients with and without prolonged hospitalization were compared by independent sample t-test, Mann-Whitney U-test, chi-square test, and Fisher's exact test as appropriate. Receiver operating characteristic (ROC) analysis was used to establish a cut-off level of postoperative PLR and SII values to predict prolonged hospitalization. Perioperative factors associated with prolonged hospitalization were evaluated by univariable and stepwise multivariable logistic regression analyses. RESULTS: Of the 106 patients undergoing PBS, 48 patients (45.28%) had prolonged hospitalization. Both postoperative PLR and SII in patients with prolonged hospitalization were significantly higher than those in patients without. The ROC curve showed that the optimal cut-off value of postoperative SII to predict prolonged hospitalization was 1073.17, with 0.792 sensitivity and 0.483 specificity. In addition, the optimal cut-off value of postoperative PLR to predict prolonged hospitalization was 227.55, with 0.604 sensitivity and 0.638 specificity. Stepwise multivariate analysis showed that postoperative SII (>1073.17) was an independent predictor for prolonged hospitalization (odds ratio = 3.527, 95% confidence interval: 1.491-8.434, p = 0.004), together with intraoperative blood transfusion requirement and preoperative prothrombin time. CONCLUSIONS: Our findings demonstrated an association between the higher level of postoperative SII and delayed recovery, suggesting that it may be a useful parameter for identifying patients at risk of delayed recovery after PBS.