Postoperative day one neutrophil-to-lymphocyte ratio as a predictor of 30-day outcomes in bariatric surgery patients.

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) is a marker that reflects systemic inflammation and organ dysfunction. Its use as a prognostic marker to predict complications following surgery has been recently described in the literature. OBJECTIVES: The objective of our study was to evaluate the use of postoperative day one (POD1) NLR as a predictor of 30-day outcomes in patients undergoing bariatric surgery. SETTING: University Hospital. METHODS: We performed a retrospective chart review of 789 patients who underwent bariatric surgery at our institution between March 2012 and May 2014. Data were collected from electronic patient records and administrative databases used for quality improvement. POD1 NLR values were obtained from complete blood counts along with a variety of 30-day clinical outcomes. Univariate and multivariable analyses were conducted to determine whether POD1 NLR ≥10 was associated with 30-day outcomes. RESULTS: Seven-hundred and thirty-seven patients were included in the study. Six-hundred and fifty-three Roux-en-Y gastric bypass surgeries (88.6 %) and 84 sleeve gastrectomy surgeries (11.4 %) were performed. All surgeries were performed laparoscopically. We observed a 4.7 % readmission rate, 2.2 % reoperation rate, 10.7 % postoperative occurrence rate, and 0.1 % mortality rate. After covariate adjustment, POD1 NLR ≥10 was found to be significantly associated with overall complications (OR 1.98, 95 % CI 1.01-3.87), major complications (OR 3.71, 95 % CI 1.76-7.82), reoperation (OR 3.63, 95 % CI 1.14-11.6), and prolonged postoperative length of stay (OR 3.70, 95 % CI 2.2-6.22). CONCLUSION: POD1 NLR was independently associated with 30-day outcomes following bariatric surgery. This easily obtained inflammatory marker may be used to help identify patients at a higher risk of developing early complications.

Readmissions Following Implantation of a Continuous-Flow Left Ventricular Assist Device.

OBJECTIVE: The objective of this study is to review and analyze readmission data for patients who received a continuous flow left ventricular assist device (LVAD). METHODS: A retrospective review of 88 patients implanted with a continuous-flow LVAD between June 2006 and June 2014 was performed. Reason for readmission, frequency, length of stay, and procedures performed during each readmission were recorded. All patients were followed in our LVAD clinic and all readmissions were reported to our program. RESULTS: Sixty-seven patients (76%) were discharged following their hospitalization for LVAD implant. In these patients, indication for LVAD support consisted of bridge to transplant (78%) and destination therapy (22%). Total device support time was 30,482 days, with an average support time of 455 ± 376 days. Forty-two patients (63%) were readmitted at least once, with an average length of readmission stay of nine days (median = 6). There were 129 readmissions totaling 1264 hospital days. The main reason for readmission was infection (17%). Despite this relatively high readmission rate, patients spent 86% of their time outside the hospital. CONCLUSION: Although common, LVAD readmissions can be appropriately managed with patients spending the majority of their support time at home. doi: 10.1111/jocs.12744 (J Card Surg 2016;31:361-364).