Pan-Immune Inflammation Value in Detecting Perioperative Complications in Patients Undergoing Laparoscopic Sleeve Gastrectomy: A Prospective Cohort Study

Obesity is a significant health problem with increasing prevalence worldwide and is associated with numerous comorbidities. In this prospective controlled study, the relationship between changes in platelet-to-lymphocyte ratio(PLR), neutrophil-to-lymphocyte ratio(NLR), and pan-immune-inflammation value(PIV)-calculated from complete blood count parameters on the preoperative day and the first postoperative day-and early major surgical complications following laparoscopic sleeve gastrectomy(LSG) was investigated. Patients scheduled for LSG due to morbid obesity at the Department of General Surgery, Kahramanmaraş Sütçü İmam University, and Elazig Private Eastern Anatolia Hospital were prospectively included in the study. Preoperative and postoperative (24-hour) complete blood count (CBC) parameters were recorded, including white blood cell count (WBC), neutrophil count, lymphocyte count, monocyte count, and platelet count. PLR, NLR, and PIV were manually calculated. Patients were divided into two groups based on whether postoperative complications developed. In the preoperative period, significant differences were observed in WBC count, neutrophil count, and PIV values between patients with and without complications (p = 0.001, p < 0.001, and p < 0.001, respectively). In the postoperative period, significant differences were found between the two groups in WBC count, neutrophil count, platelet count, PLR, NLR, and PIV (p = 0.001, p < 0.001, p < 0.001, p = 0.047, p = 0.001, and p < 0.001, respectively). When preoperative and postoperative values were compared, NLR, PLR, and PIV showed a statistically significant increase (p = 0.001, p < 0.001, and p < 0.001, respectively). Our study demonstrated that among inflammatory markers calculated from CBC parameters, the PIV-assessing the overall immune-inflammatory response-provides higher specificity and sensitivity than NLR and PLR in predicting early postoperative major complications following LSG. The primary keypoint to assess whether the changes in preoperative and postoperative PIV, NLR, and PLR values could predict early major postoperative complications following LSG. The Secondary keypoint included evaluation of perioperative major complication rates, reoperation rates, and mortality rates.