Predictive value of preoperative neutrophil-to-lymphocyte ratio for post-tonsillectomy hemorrhage: Age-specific insights from a pediatric cohort

Abstract

Objective: To evaluate the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR) for postoperative hemorrhage following pediatric tonsillectomy and to explore its age-specific performance. Methods: This retrospective study included 100 pediatric patients who underwent tonsillectomy at a single tertiary center between January 2021 and December 2025. Fifty patients with postoperative hemorrhage and 50 without bleeding were analyzed. Preoperative NLR values were compared between groups. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were performed to assess the predictive capacity of NLR. Subgroup analysis was conducted for patients aged ≤7 years. Results: The bleeding group had significantly higher preoperative NLR values compared to controls (2.72 ± 2.21 vs. 1.79 ± 0.72, p = 0.023). ROC analysis yielded an AUC of 0.632 for all patients and 0.697 for those aged ≤7 years. An NLR threshold of 2.35 provided 40 % sensitivity and 86 % specificity for predicting hemorrhage, while an NLR cut-off of 2.08 improved sensitivity (64 %) and specificity (83 %) in younger children. Multivariate analysis confirmed NLR as an independent predictor of postoperative bleeding (OR = 1.68, p = 0.016). Conclusion: Elevated preoperative NLR is associated with an increased risk of postoperative hemorrhage after pediatric tonsillectomy, particularly in children aged ≤7 years. Preoperative NLR measurement may serve as a useful adjunct in perioperative risk stratification.