Original Article

Clinical and prognostic significance of preoperative and postoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients undergoing major abdominal surgery


  • Oğuz Hançerlioğulları
  • Şahin Kaymak
  • Kürşat Okuyucu
  • Semra İnce
  • Rahman Şenocak
  • Murat Urkan
  • İsmail Hakkı Özerhan

Received Date: 08.05.2018 Accepted Date: 03.07.2018 Gulhane Med J 2018;60(4):119-124


Acute inflammatory processes are associated with perioperative complications. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) were reported to have prognostic importance in various diseases. We aimed to investigate the clinical importance of preoperative (preop) and postoperative (postop) NLR and PLR as predictors of morbidity and surgical or nonsurgical complications after major abdominal surgery.


Patients who had a major abdominal surgery were retrospectively evaluated. Age, gender, American Society of Anesthesiologist (ASA) score, and the type of operation were recorded. Preop and postop days 1, 3 and 5 white blood cell (WBC), neutrophil, lymphocyte and platelet counts, duration of intensive care unit stay and hospitalization, Clavien Dindo classification, and surgical or non-surgical complications were determined.


The study included 462 subjects. Concerning increased need for red blood cell transfusions, NLR was significantly higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 compared to preop state. Regarding a worse Clavien-Dindo classification, NLR was higher on postop day 3 but lower on day 5, and PLR was higher on postop day 1 and 3 compared to baseline. In those with increased surgical complications, NLR was lower on postop day 5, and postop day 1 and 3 PLR were higher compared to baseline values. In subjects with higher non-surgical complications, NLR was higher on postop day 3 but lower on day 5 compared to preop measurements. PLR was similar across the days of follow up in terms of non-surgical complications.


Higher NLR on postoperative day 5, and higher PLR on postoperative days 1 and 3 compared to preop values were the indicators of increased complications in this study.

Keywords: Major abdominal surgery, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR)