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Association between preoperative neutrophil–lymphocyte ratio, uric acid, and postoperative delirium in elderly patients undergoing degenerative spine surgery

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Abstract

Purpose

There are few reports regarding the association between the neutrophil–lymphocyte ratio (NLR), uric acid, and the development of postoperative delirium (POD) in patients who are undergoing spine surgeries. We investigated the associations between the NLR, uric acid as a natural antioxidant, and POD in elderly patients undergoing degenerative spine surgery.

Patients and methods

This was a single-center, observational, and retrospective study conducted in Japan. We enrolled 410 patients who underwent degenerative spine surgery. POD was diagnosed after the surgeries by psychiatrists, based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). We performed a multivariable logistic regression analysis to clarify whether the NLR and uric acid values were associated with the development of POD in the patients.

Results

129 of the 410 patients were excluded from the analysis. Of the 281 patients (137 females, 144 males), 32 patients (11.4%) were diagnosed with POD. The multivariable logistic regression analysis revealed that the preoperative uric acid level (adjusted odds ratio [aOR]: 0.67, 95% confidence interval [CI]: 0.49–0.90, p = 0.008) and age (aOR: 1.09, 95% CI: 1.02–1.16, p = 0.008) were significantly associated with POD. The preoperative NLR (aOR: 0.82, 95% CI: 0.60–1.13, p = 0.227) and antihyperuricemic medication (aOR: 0.97, 95% CI: 0.24–3.82, p = 0.959) were not significantly associated with POD.

Conclusion

Our results demonstrated that in elderly patients undergoing degenerative spine surgery, the preoperative NLR was not significantly associated with POD, but a lower preoperative uric acid value was an independent risk factor for developing POD. Uric acid could have a neuroprotective impact on POD in patients with degenerative spine diseases.

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Abbreviations

aOR:

Adjusted odds ratio

AUC:

Area under the curve

BIS:

Bispectral index

CAM:

Confused assessment method

CI:

Confidence interval

CCI:

Charlson Comorbidity Index

CRP:

C-reactive protein

IL:

Interleukin

NLR:

Neutrophil–lymphocyte ratio

POD:

Postoperative delirium

ROC:

Receiver operating characteristic

TNF-α:

Tumor necrosis factor-alpha

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Acknowledgements

Not applicable.

Funding

This study was supported by a Grant-in-Aid from the Japan Society for the Promotion of Science (no. 21K16556). The funding source had no involvement in the study design, collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan

    Kodai Kato, Hirotaka Kinoshita, Daiki Takekawa, Tetsuya Kushikata & Kazuyoshi Hirota

  2. Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan

    Gentaro Kumagai, Yohshiro Nitobe, Toru Asari, Kanichiro Wada & Yasuyuki Ishibashi

  3. Department of Perioperative Medicine for Community Healthcare, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan

    Kazuyoshi Hirota

  4. Department of Perioperative Stress Management, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan

    Kazuyoshi Hirota

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  1. Kodai Kato
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Contributions

KK collected data. HK designed the study, drafted the manuscript, collected data, and performed statistical analyses. GK designed the study, collected data, and revised the manuscript. DT performed statistical analyses and revised the manuscript. YN collected data. TA collected data. KW collected data and revised the manuscript. TK designed the study and revised the manuscript. YI and KH extensively revised the manuscript. All authors evaluated the study data and reviewed the manuscript.

Corresponding author

Correspondence to Hirotaka Kinoshita.

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Kato, K., Kinoshita, H., Kumagai, G. et al. Association between preoperative neutrophil–lymphocyte ratio, uric acid, and postoperative delirium in elderly patients undergoing degenerative spine surgery. J Anesth 38, 35–43 (2024). https://doi.org/10.1007/s00540-023-03273-6

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