Postoperative inflammatory markers as early predictive factors for prolonged postoperative hospital stay after highly advanced hepatobiliary-pancreatic surgery: A single-center retrospective study

Abstract Background Postoperative length of hospital stay (PLOS) is a crucial measure of surgical quality. Prolonged PLOS (PPLOS) escalates treatment costs and delays the transition from surgery to adjuvant chemotherapy. Additionally, PPLOS can negatively affect long-term prognosis. The predictive factors for PPLOS, particularly following highly advanced hepatobiliary-pancreatic surgery (HBPS), have not been thoroughly investigated. In this study, we aimed to identify perioperative predictive factors for PPLOS following highly advanced HBPS. Methods This single-center retrospective study enrolled 737 patients at Gifu University Hospital, Japan, who underwent highly advanced HBPS between January 2010 and December 2023. Perioperative predictive factors for PPLOS were evaluated in patients with severe postoperative complications (n = 190; Clavien–Dindo classification grades ≥ III) in univariate and multivariate analyses. Results Among the included patients, 97 had PPLOS, and patients with severe postoperative complications had a median PLOS of 40 days. Preoperative body mass index, pancreatic surgery, C-reactive protein to albumin ratio (CAR) on postoperative day (POD)3, and neutrophil to lymphocyte ratio (NLR) on POD3 showed significant correlations with PPLOS in univariate analysis. Multivariate analysis showed that CAR on POD3 (> 5.0, odds ratio [OR], 2.79; 95% confidence interval [CI], 1.32–6.05; p  20.0, OR, 2.92; 95% CI, 1.23–7.59; p = 0.01) were independent predictive factors for PPLOS. Conclusions Regardless of the type of surgery (hepatobiliary or pancreatic), significant PLOS prolongation was observed following highly advanced HBPS, depending on the presence and severity of postoperative complications. In patients with serious postoperative complications, postoperative inflammatory markers such as CAR and NLR on POD3 may be early predictive factors for PPLOS. This study emphasizes the need for early and effective postoperative management based on inflammatory markers to prevent prolonged severe complications, which can result in shorter PLOS following highly advanced HBPS.