{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:24:10Z","timestamp":1786965850748,"version":"build-2736575974"},"reference-count":23,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Systemic inflammation may influence postoperative pain, but simple preoperative markers of pain risk are lacking in bariatric surgery. We examined whether the preoperative neutrophil-to-lymphocyte ratio (NLR) and immature granulocyte percentage (IG%) are associated with pain severity after laparoscopic sleeve gastrectomy (LSG). Methods: In this single-center retrospective cohort, records of 81 adults undergoing LSG were reviewed. Pain was rated on the 11-point numeric rating scale (NRS) in the recovery unit, at 24 h, and at 3 months. As NRS is ordinal, associations were assessed with Spearman correlation, covariate-adjusted ordinal logistic (proportional-odds) regression, NLR tertiles with a trend test, and receiver-operating-characteristic (ROC) analysis. Results: Preoperative NLR correlated positively with recovery unit NRS (rho = 0.36), 24 h NRS (rho = 0.37), and 3-month NRS (rho = 0.61; all p \u2264 0.001). After multivariable adjustment, log-NLR remained independently associated with recovery unit pain (odds ratio 6.1) and 24 h pain (odds ratio 8.1; both p &lt; 0.001), with a graded relationship across tertiles (p for trend \u2264 0.020). For moderate-to-severe recovery unit pain, NLR discriminated with an area under the curve of 0.79 (optimal cutoff &gt; 1.73). Neither IG% nor absolute IG was associated with any pain outcome (all p &gt; 0.110). Conclusions: Higher preoperative NLR was independently and dose-dependently associated with greater early postoperative pain after LSG, whereas IG showed no association. NLR is a routinely available, essentially cost-free value that may help flag patients at risk of more severe early postoperative pain; prospective validation is warranted.<\/jats:p>","DOI":"10.3390\/diagnostics16162579","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:04:36Z","timestamp":1786961076000},"page":"2579","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of Preoperative Neutrophil-to-Lymphocyte Ratio and Immature Granulocytes with Postoperative Pain After Laparoscopic Sleeve Gastrectomy: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1699-3372","authenticated-orcid":false,"given":"Mustafa","family":"\u00d6zdemir","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, F\u0131rat University, 23119 Elaz\u0131\u011f, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Aslan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Faculty of Medicine, F\u0131rat University, 23119 Elaz\u0131\u011f, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feyzanur","family":"Cavlak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, F\u0131rat University, 23119 Elaz\u0131\u011f, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurettin","family":"Yan\u0131k","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, F\u0131rat University, 23119 Elaz\u0131\u011f, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"ref_1","first-page":"6593736","article-title":"Risk factors for moderate to severe pain during the first 24 h after laparoscopic bariatric surgery while receiving intravenous patient-controlled analgesia","volume":"2019","author":"Iamaroon","year":"2019","journal-title":"Anesthesiol. Res. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1007\/s00268-019-04934-y","article-title":"Evidence-based management of postoperative pain in adults undergoing laparoscopic sleeve gastrectomy","volume":"43","author":"Macfater","year":"2019","journal-title":"World J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Mieszcza\u0144ski, P., Jurczak, M., Ko\u0142acz, M., G\u00f3rniewski, G., Godlewska, I., Ziemia\u0144ski, P., Cylke, R., Lisik, W., and Trzebicki, J. (2025). Chronic post-surgical pain after laparoscopic sleeve gastrectomy: Is the opioid-free anesthesia superior? A cross-sectional study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217721"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Wuyts, S.C.M., Torensma, B., Schellekens, A.F.A., and Kramers, C. (2023). Opioid analgesics after bariatric surgery: A scoping review to evaluate physiological risk factors for opioid-related harm. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134296"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.4103\/1119-3077.181399","article-title":"Neutrophil lymphocyte ratio predicts postoperative pain after orthognathic surgery","volume":"20","author":"Turgut","year":"2017","journal-title":"Niger. J. Clin. Pract."},{"key":"ref_6","first-page":"e88230","article-title":"Relationship between preoperative neutrophil-to-lymphocyte ratio and patient-controlled analgesia consumption following cardiac surgery: A retrospective study","volume":"17","author":"Akiyama","year":"2025","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Guo, K., Zeng, J., Lu, J., Guo, Y., Shan, P., Huang, Y., and Wu, D. (2024). The clinical significance of the neutrophil-to-lymphocyte ratio as a novel inflammatory biomarker for assessing the severity of intervertebral disc degeneration. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1446124"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1309\/LT30BV9UJJV9CFHQ","article-title":"Immature granulocyte measurement using the Sysmex XE-2100: Relationship to infection and sepsis","volume":"120","author":"Kickler","year":"2003","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nierhaus, A., Klatte, S., Linssen, J., Eismann, N.M., Wichmann, D., Hedke, J., Braune, S.A., and Kluge, S. (2013). Revisiting the white blood cell count: Immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis\u2014A prospective, observational study. BMC Immunol., 14.","DOI":"10.1186\/1471-2172-14-8"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/bja\/aen103","article-title":"Assessment of pain","volume":"101","author":"Breivik","year":"2008","journal-title":"Br. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1093\/bja\/aer195","article-title":"Determination of moderate-to-severe postoperative pain on the numeric rating scale: A cut-off point analysis applying four different methods","volume":"107","author":"Gerbershagen","year":"2011","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: A practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B Stat. Methodol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/j.2517-6161.1980.tb01109.x","article-title":"Regression models for ordinal data","volume":"42","author":"McCullagh","year":"1980","journal-title":"J. R. Stat. Soc. Ser. B Methodol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.2307\/2532457","article-title":"Assessing proportionality in the proportional odds model for ordinal logistic regression","volume":"46","author":"Brant","year":"1990","journal-title":"Biometrics"},{"key":"ref_17","first-page":"e43782","article-title":"Relationship between pre- and post-operative C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) with post-operative pain after total hip and knee arthroplasty: An observational study","volume":"15","author":"Rathee","year":"2023","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Shu, B., Xu, F., Zheng, X., Zhang, Y., Liu, Q., Li, S., Chen, J., Chen, Y., Huang, H., and Duan, G. (2023). Change in perioperative neutrophil-lymphocyte ratio as a potential predictive biomarker for chronic postsurgical pain and quality of life: An ambispective observational cohort study. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1177285"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1038\/nri3399","article-title":"Neutrophil recruitment and function in health and inflammation","volume":"13","author":"Kolaczkowska","year":"2013","journal-title":"Nat. Rev. Immunol."},{"key":"ref_20","first-page":"e33955","article-title":"Can neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, or systemic immune inflammation index be an indicator of postoperative pain in patients undergoing laparoscopic cholecystectomy?","volume":"15","author":"Akyurt","year":"2023","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"674","DOI":"10.14444\/8290","article-title":"Does preoperative neutrophil-lymphocyte ratio predict patient-reported pain and functional outcomes at 12 months after lumbar fusion?","volume":"16","author":"Osunronbi","year":"2022","journal-title":"Int. J. Spine Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Gkrinia, E.M.M., and Belan\u010di\u0107, A. (2025). The mechanisms of chronic inflammation in obesity and potential therapeutic strategies: A narrative review. Curr. Issues Mol. Biol., 47.","DOI":"10.3390\/cimb47050357"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kim, S.H., Stoicea, N., Soghomonyan, S., and Bergese, S.D. (2014). Intraoperative use of remifentanil and opioid induced hyperalgesia\/acute opioid tolerance: Systematic review. Front. Pharmacol., 5.","DOI":"10.3389\/fphar.2014.00108"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/16\/2579\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:25:35Z","timestamp":1786962335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/16\/2579"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,15]]},"references-count":23,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["diagnostics16162579"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16162579","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,15]]}}}