EP346 - The platelet-to-lymphocyte ratio as a predictor of postoperative morbidity following Hartmann’s reversal: a useful inflammatory marker?

Purpose/Background: The platelet-to-lymphocyte ratio (PLR) has emerged as a simple and cost-effective biomarker of systemic inflammation, with growing evidence supporting its prognostic value for postoperative morbidity across a variety of abdominal surgical conditions. Elevated preoperative PLR has been consistently linked to worse postoperative outcomes in several contexts; however, its predictive value in patients undergoing Hartmann's reversal has not yet been specifically investigated. Further evaluation of PLR in this setting may provide a useful tool for perioperative risk stratification.

To assess the prognostic value of the platelet-to-lymphocyte ratio (PLR) as an inflammatory biomarker for predicting postoperative complications, including anastomotic leak, surgical reintervention, and 30-day readmission, in patients undergoing Hartmann's reversal.

Methods/Interventions: A retrospective analytical study of 55 patients undergoing Hartmann's reversal was performed to evaluate the platelet-to-lymphocyte ratio (PLR) as a predictor of postoperative morbidity. Outcomes included anastomotic leak, reintervention, and 30-day readmission. Statistical analysis was conducted using SPSS Statistics version 30.0 (p < 0.05).

Results/Outcomes: Pearson's correlation analysis showed a significant negative association between PLR and the presence of an anastomotic leak (r = -0.345, p = 0.011). Mean comparison revealed that patients with a leak had significantly higher PLR values (246.2 ± 198.3) than those without (144.6 ± 70.3), with a mean difference of 101.5 (95% CI: 24.8-178.3, p = 0.011). The effect size indicated a large magnitude, confirming the clinical relevance of this finding.

Patients requiring reintervention had significantly higher mean PLR values (225.2 ± 179.9) compared with those who did not (144.3 ± 70.4; p = 0.025). The mean difference was 80.9 (95% CI: 10.7-151.1), with a large effect size suggesting that an elevated PLR may predict the need for postoperative reintervention.

PLR was significantly higher in patients who were readmitted within 30 days (315.7 ± 222.9) compared with those without readmission (145.2 ± 74.1; p < 0.001). The effect size was very large (Cohen's d = 1.90, 95% CI: 0.81-2.97), reinforcing the role of PLR as a marker for early postoperative adverse events.

The ROC curve for 30-day readmission yielded an area under the curve (AUC) of 0.648 (95% CI: 0.465-0.831, p = 0.113), indicating a moderate discriminative capacity. However, when major outcomes (leak and reintervention) were compared, a significant difference in AUC was observed (ΔAUC = 0.352, z = 3.78, p < 0.001), demonstrating superior performance of PLR in identifying patients at higher risk for severe postoperative events.

Conclusion/Discussion: The platelet-to-lymphocyte ratio (PLR) demonstrated significant associations with key postoperative outcomes in patients undergoing Hartmann's reversal. Higher PLR values were strongly correlated with anastomotic leak, surgical reintervention, and 30-day readmission, indicating its potential as a reliable inflammatory biomarker for predicting postoperative morbidity.

These findings suggest that preoperative PLR assessment could serve as a simple, inexpensive, and readily available tool to stratify risk and optimize perioperative management in patients scheduled for Hartmann's reversal. Further multicenter studies are warranted to validate these results and to determine standardized cutoff values for clinical use.

Table 1. Comparative Table: Platelet-to-Lymphocyte Ratio (PLR) according to postoperative outcomes
Note: Values are presented as mean ± standard deviation (SD).
Figure 1. Receiver Operating Characteristic (ROC) Curves for Platelet-to-Lymphocyte Ratio (PLR)
Note: Receiver Operating Characteristic (ROC) curves illustrating the discriminative ability of the platelet-to-lymphocyte ratio (PLR) to predict major postoperative outcomes following Hartmann's reversal, including 30-day readmission (AUC = 0.65), surgical reintervention (AUC ≈ 0.70), and anastomotic leak (AUC ≈ 0.70). The diagonal line represents the reference of no discrimination.