A retrospective comparative analysis of systemic inflammatory response after laparoscopic, vaginal, and abdominal hysterectomy

Background: Lymphocyte to neutrophil ratio (NLR) is a rapid and simple marker for systemic inflammation and stress after major surgery. In this study, we aimed to compare NLR changes according to surgical methods of hysterectomy. Methods: A retrospective chart review for all patients who underwent hysterectomy for benign uterine disease from 2016 to 2020 was performed. A total of 1549 women were assigned to total laparoscopic hysterectomy (TLH) (n = 419), vaginal hysterectomy (VH) (n = 608), and total abdominal hysterectomy (TAH) (n = 522) groups. Patient characteristics, surgical outcomes, and NLR changes were compared among women who underwent TLH, VH, and TAH. Results: Preoperative mean NLR was similar among three groups (p = 0.056). However, mean NLR on postoperative day 1 (p < 0.0001) and day 3 (p = 0.011) was significantly lower in TLH group than others. Also, mean NLR change on postoperative day 1 was significantly lesser in TLH group than others (1.9 in TLH vs. 5.4 in VH vs. 4.7 in TAH; p < 0.0001). Mean NLR change on postoperative day 3 was greater in TAH group than others, although there were no statistically significant differences (0.2 in TLH vs. 0.3 in VH vs. 0.7 in TAH; p = 0.354). Multivariate analysis revealed that massive NLR change (>5.0) on postoperative day 1 was significantly associated with types of hysterectomy (p < 0.0001). Conclusion: Our data showed that acute NLR change was lesser in TLH group comparing to VH and TAH group, which suggests that TLH might be associated with less systemic inflammation and tissue trauma after surgery.