Is Preoperative Serum Albumin Enough to Ensure Nutritional Status in the Development of Surgical Site Infection Following Gastrointestinal Surgery?

OBJECTIVENutritional deficiency negatively affects outcomes in many health conditions. In spine surgery, evidence linking preoperative nutritional deficiency to postoperative surgical site infection (SSI) has been limited to small retrospective studies. Authors of the current study analyzed a large consecutive cohort of patients who had undergone elective spine surgery to determine the relationship between a serum biomarker of nutritional status (preoperative prealbumin levels) and SSI.METHODSThe authors conducted a retrospective review of the electronic medical charts of patients who had undergone posterior spinal surgeries and whose preoperative prealbumin level was available. Additional data pertinent to the risk of SSI were also collected. Patients who developed a postoperative SSI were identified, and risk factors for postoperative SSI were analyzed. Nutritional deficiency was defined as a preoperative serum prealbumin level ≤ 20 mg/dl.RESULTSAmong a consecutive series of 387 patients who met the study criteria for inclusion, the infection rate for those with preoperative prealbumin ≤ 20 mg/dl was 17.8% (13/73), versus 4.8% (15/314) for those with preoperative prealbumin > 20 mg/dl. On univariate and multivariate analysis a low preoperative prealbumin level was a risk factor for postoperative SSI with a crude OR of 4.29 (p < 0.01) and an adjusted OR of 3.28 (p = 0.02). In addition, several previously known risk factors for infection, including diabetes, spinal fusion, and number of operative levels, were significant for the development of an SSI.CONCLUSIONSIn this consecutive series, preoperative prealbumin levels, a serum biomarker of nutritional status, correlated with the risk of SSI in elective spine surgery. Prehabilitation before spine surgery, including strategies to improve nutritional status in patients with nutritional deficiencies, may increase value and improve spine care.

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Identification of Predictors of Surgical Site Infection in Patients With Gastric Cancer Undergoing Surgery With Curative Intent

International Surgery ◽

10.9738/intsurg-d-16-00201.1 ◽

2017 ◽

Vol 102 (3-4) ◽

pp. 157-164 ◽

Cited By ~ 1

Author(s):

Yuji Toiyama ◽

Tadanobu Shimura ◽

Hiromi Yasuda ◽

Shigeyuki Yoshiyama ◽

Susumu Saigusa ◽

...

Keyword(s):

Gastric Cancer ◽

Serum Albumin ◽

Surgical Site Infection ◽

Operation Time ◽

Albumin Concentration ◽

Site Infection ◽

Curative Surgery ◽

Neutrophil Lymphocyte Ratio ◽

Preoperative Serum ◽

Duration Of Surgery

Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. The purpose of this study was to determine preoperative and operative predictors of SSIs after gastric resection with lymphadenectomy in patients with gastric cancer (GC). Data on clinicopathologic factors, including operative and preoperative laboratory factors, for 384 patients with GC who had undergone curative surgery were analyzed in this retrospective study to assess their associations with SSIs. Superficial/deep incisional SSIs (iSSIs) and organ/space SSIs (o/sSSIs) occurred in 18 (4.6%), and 27 (7.0%), respectively. The o/sSSIs were significantly associated with surgery-related factors such as duration of operation, blood loss, and extent of tumor. Additionally, high levels of preoperative indicators of systemic inflammation, including neutrophil counts, neutrophil/lymphocyte ratio, and C-reactive protein concentrations, were significantly associated with o/sSSIs. Multivariate analyses demonstrated that preoperative neutrophil counts and duration of surgery were independent predictors for o/sSSIs, whereas only preoperative serum albumin concentration was predicted for iSSIs. In patients with GC undergoing curative surgery, preoperative neutrophil count and operation time are potentially valuable predictors of o/sSSIs, whereas only preoperative serum albumin predicts iSSIs.

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A comparison of preoperative hypoalbuminaemia with the NNIS and SENIC risk scores for the prediction of surgical site infection in a South African setting

Journal of Medical Laboratory Science & Technology of South Africa ◽

10.36303/jmlstsa.2020.2.1.33 ◽

2020 ◽

pp. 36-40 ◽

Cited By ~ 1

Author(s):

N Naidoo ◽

TE Madiba ◽

Y Moodley

Keyword(s):

Serum Albumin ◽

Surgical Site Infection ◽

South African ◽

Risk Score ◽

Predictive Accuracy ◽

Risk Scores ◽

Site Infection ◽

Roc Curve Analysis ◽

Study Objective ◽

Preoperative Serum

Introduction: Preoperative hypoalbuminaemia is a risk factor for surgical site infection (SSI) in the South African (SA) setting. However, the predictive accuracy of preoperative hypoalbuminaemia has not been tested against established SSI risk stratification models in our setting, which could have important implications for SSI prevention strategies. With reference to SSI in SA settings, the study objective was to compare the overall predictive accuracy of preoperative hypoalbuminaemia with that obtained for the SENIC/NNIS risk scores. Method: This was a sub-analysis of a pre-existing laparotomy patient registry (N = 439). Variables collected as part of the registry included preoperative serum albumin measurements and all parameters of the SENIC/NNIS risk scores. Preoperative hypoalbuminaemia was defined as preoperative serum albumin of < 30 g/L. The study outcome was SSI up to 30 days postoperatively. Overall predictive accuracy was determined through a receiver operator-characteristic (ROC) curve analysis, with results presented as C-statistics (95% confidence intervals [CI]). Results: The C-statistics obtained for preoperative hypoalbuminaemia, the SENIC risk score, and the NNIS risk score were 0.677 (CI: 0.609–0.746), 0.652 (CI: 0.582–0.721), and 0.634 (CI: 0.563–0.705). Conclusion: All three methods display similar predictive accuracy for SSI. However, preoperative hypoalbuminaemia has several practical advantages over the SENIC/NNIS scores which must be considered.

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Should we change reference range for serum albumin in major gastrointestinal surgery? Preoperative serum albumin as an important prognostic factor

Journal of Perioperative Practice ◽

10.1177/1750458919875583 ◽

2019 ◽

Vol 30 (9) ◽

pp. 271-276

Author(s):

Piotr F Czempik ◽

Kinga Czepczor ◽

Marcelina Z Czok

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Nutritional Status ◽

Serum Albumin ◽

Gastrointestinal Surgery ◽

Total Serum Protein ◽

Total Serum ◽

Laboratory Markers ◽

Preoperative Serum

Introduction The aim of the study was to analyse prognostic value of laboratory markers of nutritional status in gastrointestinal surgery. Methods We performed a retrospective analysis of clinical and laboratory data of 102 patients admitted to an Intensive Care Unit following elective gastrointestinal surgery. The outcome measures included hospital mortality, infectious complications, surgical complications and length of stay. Results Forty-eight patients had all three laboratory markers of nutritional status determined before surgery and these patients constituted our study group. We found correlations between preoperative serum albumin and hospital mortality, risk of reoperation and urinary tract infection. Preoperative total serum protein correlated with urinary tract infection. Total lymphocyte count was predictive of bacteraemia. No statistically significant correlations were found between markers of nutritional status and length of stay. Conclusions Serum albumin concentration at the lower limit is associated with increased mortality, reoperation, urinary tract infection. Total serum protein predicts urinary tract infection, whereas total lymphocyte count predicts bacteraemia.

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The risk factors of surgical site infection following posterior cervical spine surgery

10.21203/rs.3.rs-331817/v1 ◽

2021 ◽

Author(s):

Yvang Chang ◽

Ming Yang ◽

Wentao Zhang ◽

Gang Xu ◽

Zhonghai Li

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Cervical Spine ◽

Serum Albumin ◽

Surgical Site Infection ◽

Spine Surgery ◽

Patient Specific ◽

Site Infection ◽

Cervical Spine Surgery ◽

Preoperative Serum

Abstract Background: Surgical site infection (SSI) is a common complication following posterior cervical spine surgery, imposing a high burden on patients and society. However, information about its characteristics and related risk factors is limited. We designed this study intended to address this issue.Methods: From January 2011 through October 2020, a total of 405 patients diagnosed of cervical degenerative diseases (cervical spondylotic myelopathy, ossification of posterior longitudinal ligament and cervical disk herniation) who were treated with unilateral open-door lamnioplasty surgeries were enrolled in this study. We divided the patients into the SSI group and the non-SSI group and compared their patient-specific and procedure-specific factors. Univariate and multiple logistic regression analyses were performed to determine risk factors. Results: There were significant differences between groups in subcutaneous fat thickness (FT) (P<0.001), ratio of subcutaneous FT to muscle thickness (MT) (P<0.001), preoperative Japanese Orthopaedic Association（JOA）Scores (P< 0.003), preoperative serum albumin (P< 0.001), postoperative drainage (P<0.004), time of draining (P<0.001). Logistic regression analysis of these differences showed that ratio of subcutaneous FT/MT, preoperative JOA score, preoperative serum albumin and longer time of draining were significantly related to SSI (P<0.05).Conclusion: Ratio of subcutaneous FT/MT, preoperative JOA score, preoperative serum albumin and longer time of draining are identified as the independent risk factors of SSI in posterior cervical spine surgeries. Identification of these risk factors could be useful in reducing SSI incidence and patients counseling.

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