Evaluating neutrophil/lymphocyte ratio as a predictor of 30-day high-grade complications following renal surgery.

Abstract

659 Background: Radical nephrectomy (RN) and partial nephrectomy (PN) for patients with renal cortical masses may carry significant risk for postoperative complications. We analyzed patient demographics and serum laboratories and morphometric measures to determine predictors of 30-day complications following RN and PN. Methods: Single institution retrospective analysis of RNs and PNs between 7/2008-4/2017. Demographic and clinical characteristics, serum laboratories, and RENAL nephrometry score were recorded. 30-day complications were graded according to the modified Clavien classification system. Primary purpose was to identify predictive factors associated with 30-day complications overall. Secondary purposes included identification of predictive factors high-grade complications (HGC; Clavien ≥3) overall and in the PN group. Factors were screened with logistic regression analysis. Results: 814 patients were analyzed (460 PN, 354 RN). 190 (23%) patients experienced 30-day complications, 107/460 (23%) PN and 83/354 (24%) RN (p = 0.951). Albumin level ≤3.5 mg/dL was predictive of overall complications (OR = 4.803, p = .008), while minimally invasive surgery (MIS) was negatively associated (OR 0.444, p < .001). Overall, 76 (9.3%) HGCs occurred, 52/460 (11%) in PN and 24/354 (6.8%) in RN (p = .028). Preoperative Neutrophil-Lymphocyte Ratio (NLR) of ≥2.78 (OR 3.216, p = .016) was a predictor of HGCs overall. MIS was negatively associated with HGCs (OR 0.444, p > .001). In the PN group only MIS was negatively associated with overall complications (OR 0.323, p < .001) and HGCs (OR 0.259, p < .001). Conclusions: While decreased serum albumin was predictive of overall complications in patients undergoing PN and RN, elevated preoperative NLR is a novel predictor for HGC. Use of serum markers may be incorporated in preoperative risk stratification counseling and nomograms.