Can Neutrophil-to-Lymphocyte or Platelet-to-Lymphocyte Ratio Be Used to Predict Postoperative Nausea and Vomiting in Breast Reduction?

Onur Karaca,Guvenc Dogan

doi:10.7759/cureus.7237

Abstract

Background/ObjectivePostoperative nausea and vomiting (PONV) is one of the most frequently seen complications in the postoperative period. In several studies, the neutrophil-lymphocyte ratio (NLR) or the thrombocyte-lymphocyte ratio (PLR) has been suggested as a parameter to be used in the diagnosis of inflammatory diseases. However, the literature provides no information about this relationship for breast reduction. This study aims to investigate whether preoperative NLR or PLR was an indicator of PONV and identify its relationship with antiemetic use.MethodsIn this study, hemogram values and antiemetic amounts taken within 24 hours were obtained retrospectively by scanning the files of the patients received breast reduction diagnosis and operation. The confounder effect was controlled using the Propensity Score Matching analysis to distribute the case-control groups similarly. The Receiver Operating Characteristic (ROC) analysis was used to determine whether NLR and PLR could be a prognostic indicator for PONV prediction. Sensitivity and specificity values were calculated after the ROC analysis to determine the success of the cut-off points.ResultsThe success of NLR and PLR in discriminating PONV was found to be statistically significant (cut-off: 1.97, area under the curve (AUC)=0.697, p=0.001, cut-off: 137.2, AUC=0.743; p<0.001, respectively). In addition, the sensitivity of PLR (77.8%) in discriminating PONV was found to be higher in comparison to NLR (73.3%).ConclusionsOne of the factors decreasing patient care quality and satisfaction is PONV. The results of this study showed that preoperative NLR and PLR could be taken into consideration in antiemetic use required for the prevention of postoperative nausea-vomiting in breast-reduction operations.

Highlights

Postoperative nausea and vomiting (PONV) is defined as gagging or nausea-vomiting within the postoperative 24 hours [1,2,3,4].The prevalence of nausea and vomiting changes according to the surgical cases performed under general anesthesia and, generally, its incidence is reported to be between 30% and 80% [2,3,4]
This study aims to investigate whether preoperative neutrophil-lymphocyte ratio (NLR) or PLR was an indicator of PONV and identify its relationship with antiemetic use
The results of this study showed that preoperative NLR and PLR could be taken into consideration in antiemetic use required for the prevention of postoperative nausea-vomiting in breast-reduction operations

Summary

Introduction

Postoperative nausea and vomiting (PONV) is defined as gagging or nausea-vomiting within the postoperative 24 hours [1,2,3,4].The prevalence of nausea and vomiting changes according to the surgical cases performed under general anesthesia and, generally, its incidence is reported to be between 30% and 80% [2,3,4]. Nausea and vomiting are among the important problems that commonly occur in the postoperative period and that decreases patient satisfaction [5]. Despite the developments in the management of nausea and vomiting and new antiemetic medicine, postoperative nausea and vomiting remain to be an important problem for patients [2,4]. Several risk factors play an important role in PONV development [7,8]. PONV-related important risk factors include patientrelated, anesthetic, and surgical factors. The most important patient-related risk factor is being female; and the other factors include having a history of nausea and vomiting in the postoperative period, not smoking, motion sickness history, and young age. Anesthetic factors that play a role in PONV development include

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