Introduction Accurate prediction of outcome after emergency surgery in the elderly patient may assist decision making. However, certain scoring systems require post-operative data (eg, P-POSSUM) while others have failed to gain widespread use (eg, Surgical risk score). Recent reports have suggested that C reactive protein (CRP) and the neutrophil lymphocyte (N/L ratio) ratio may predict surgical outcome.
Methods A retrospective review of consecutive unselected patients aged 80 years or over undergoing emergency abdominal surgery over a 22-month period was performed. Univariate, multivariate and recursive analyses were performed and findings validated using an independent data-set.
Results 88 patients were identified, median age 84 years. 30-day mortality was 31%, 6-month mortality 43% and 12-month mortality 50%. Univariate analysis revealed age, N/L ratio, CRP, midline laparotomy, ASA and surgical risk score to predict outcome at set time points. Using a recursive approach N/L ratio>22 (p=0.0018) best predicted 30-day outcome. On multivariate analysis, N/L ratio was an independent predictor of 30-day outcome (p=0.004, df=1, χ2=8.144) while CRP failed to predict outcome at any time point. In an independent dataset (n=84), N/L ratio was an independent prognostic factor at 30 days (p=0.001, df=2, χ2=15.071), 6 months (p<0.001, df=1, χ2=12.536) and 12 months (p=0.001, df=1 χ2=10.27).
Conclusion We suggest that N/L is an easily calculable pre-operative measure that may have utility in the prediction of outcome after emergency abdominal surgery in the elderly. Further work to validate this measure in a larger, prospective setting and determine why N/L ratio predicts outcome is necessary.
Competing interests None declared.
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