title: Pre-operative serum albumin and neutrophil-lymphocyte ratio are associated with prolonged hospital stay following colorectal cancer surgery.
abstract: OBJECTIVE
  Colorectal cancer is the third most common cancer in European populations. It has been shown previously that neutrophil-lymphocyte ratio (NLR), pre-operative albumin, and haemoglobin are useful prognostic indicators. The aim of this study was to assess how these factors influence the length of postoperative stay (LOS) following colorectal cancer surgery.
  
  
  METHODS
  All patients undergoing elective colorectal resections for malignancy between 2010 and 2011 in Pilgrim Hospital, Boston, U.K. were considered for the study. Hospital archive systems were used to ascertain pre-operative NLR, albumin and haemoglobin levels. LOS was calculated from electronic discharge documents with day 1 being the day after surgery. Unifactorial and multifactorial analyses were performed to identify independent predictors of prolonged stay.
  
  
  RESULTS
  196 patients were included in the study. Pre-operative haemoglobin was not associated with prolonged hospital stay. On univariate analysis, pre-operative serum albumin and pre-operative NLR were associated with prolonged hospital stay. On multivariate analysis, pre-operative serum albumin >34.5 g/dl (odds ratio, 0.47; 95% confidence interval, 0.24 - 0.92;p= 0.027) retained independent association for prolonged hospital stay .However, pre-operative NLR failed to reach statistical significance on multivariate analysis.
  
  
  CONCLUSIONS
  Patients with low albumin and elevated NLR are more likely to have an increased hospital stay following colorectal cancer surgery. This may be useful for surgeons in terms of identifying the 'high-risk' patient post-operatively and allow for early intervention.
authors.affiliation: Department of General Surgery, Pilgrim Hospital, Sibsey Rd, Boston, Lincolnshire PE21 9QS. U.K.
authors.forename: Rohit
authors.initials: R
authors.lastname: Gohil
authors.affiliation: Department of General Surgery, Pilgrim Hospital, Sibsey Rd, Boston, Lincolnshire PE21 9QS. U.K.
authors.forename: Majed
authors.initials: M
authors.lastname: Rishi
authors.affiliation: Department of General Surgery, Pilgrim Hospital, Sibsey Rd, Boston, Lincolnshire PE21 9QS. U.K ; Division of Gastrointestinal Surgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, NG7 2UH. U.K.
authors.forename: Benjamin H L
authors.initials: BH
authors.lastname: Tan
keywords: Colorectal cancer; length of post-operative stay; neutrophil-lymphocyte ratio; serum albumin