Surgical Site Infection – Relevance of Preoperative Assessment of Albumin and Cholesterol

Title: Surgical Site Infection – Relevance of Preoperative Assessment of Albumin and Cholesterol

Authors: Dr Nowshad.M, Dr C.V.Rajendran, Dr Jameela Beevi

DOI: https://dx.doi.org/10.18535/jmscr/v5i7.48

Abstract

Background: Surgical site infection is a serious problem affecting about 2% of all surgical procedure. Advances in surgical sciences and care has not reduced the prevalence to such an extent. Various risk factors like Age, nutritional status, diabetes, smoking, obesity, altered immune status were reported in literature. There are a few reports in the literature about the role for measurements of preoperative albumin and cholesterol. However there is a lack of such studies in our settings. We set out to study whether there is an association between the preoperative levels of albumin and cholesterol with postoperative surgical site infection.

Methods: We conducted this prospective cohort study in patients who underwent various surgeries in our institution after getting informed consent. Apart from the basic demographic profile, preoperative levels of albumin and cholesterol were measured along with preoperative, anesthetic and perioperative details. All statistical analysis was done in R statistical software.

Results: The mean ± SD age of patients was 53.1 ± 18.1 years (range 10-92 years) and 15.5% developed nosocomial infection. Hypoalbuminemia was present in 87(33%)of the patients. Hypoalbuminemia was found to be associated with SSI with a relative risk of 1.98 and confidence interval of 1.07 to 3.61. High cholesterol levels were found in 87 patients with 3(1%) only having SSI.

Discussion: In this study, we observed that there was a positive association between Hypoalbuminemia and SSI which was statistically significant. Hence routine measurement of serum albumin and cholesterol at the time of admission will help in proper optimization of surgical patients so that potential SSI could be reduced.

References

1. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. American journal of infection control 2009; 37(5): 387-97.

2. Burke JP. Infection control--a problem for patient safety. The New England journal of medicine 2003; 348(7): 651.

3. Guo Sa, DiPietro LA. Factors affecting wound healing. Journal of dental research 2010; 89(3): 219-29.

4. Owens C, Stoessel K. Surgical site infections: epidemiology, microbiology and prevention. Journal of Hospital Infection 2008; 70: 3-10.

5. Nagachinta T, Stephens M, Reitz B, Polk BF. Risk factors for surgical-wound infection following cardiac surgery. Journal of Infectious Diseases 1987; 156(6): 967-73.

6. Prabhu R. A STUDY ON SURGICAL SITE INFECTIONS. Int J Modn Res Revs 2014; 2(10): 333-5.

7. Thiele RH, Huffmyer JL, Nemergut EC. The “six sigma approach” to the operating room environment and infection. Best Practice & Research Clinical Anaesthesiology 2008; 22(3): 537-52.

8. Anderson DJ, Kaye KS. Staphylococcal surgical site infections. Infectious disease clinics of North America 2009; 23(1): 53-72.

9. Delgado-Rodríguez M, Medina-Cuadros M, Gómez-Ortega A, et al. Cholesterol and serum albumin levels as predictors of cross infection, death, and length of hospital stay. Archives of surgery 2002; 137(7): 805-12.

10. Cheadle WG. Risk factors for surgical site infection. Surgical infections 2006; 7(S1): s7-s11.

11. Wakefield C, Carey P, Foulds S, Monson J, Guillou P. Changes in major histocom-patibility complex class II expression in monocytes and T cells of patients developing infection after surgery. British journal of surgery 1993; 80(2): 205-9.

12. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Archives of surgery 1999; 134(1): 36-42.

13. Canturk N, Canturk Z, Okay E, Yirmibesoglu O, Eraldemir B. Risk of nosocomial infections and effects of total cholesterol, HDL cholesterol in surgical patients. Clinical Nutrition 2002; 21(5): 431-6.

14. Delgado-Rodríguez M, Medina-Cuadros M, Martínez-Gallego G, Sillero-Arenas M. Total cholesterol, HDL-cholesterol, and risk of nosocomial infection: a prospective study in surgical patients. Infection Control & Hospital Epidemiology 1997; 18(01): 9-18.

15. Chien J-Y, Jerng J-S, Yu C-J, Yang P-C. Low serum level of high-density lipoprotein cholesterol is a poor prognostic factor for severe sepsis. Critical care medicine 2005; 33(8): 1688-93.

16. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. American journal of infection control 1992; 20(5): 271-4.

17. Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF. Multivariable Predictors of Postoperative Surgical Site Infection after General and Vascular Surgery: Results from the Patient Safety in Surgery Study. Journal of the American College of Surgeons 2007; 204(6): 1178-87.

18. Haridas M, Malangoni MA. Predictive factors for surgical site infection in general surgery. Surgery 2008; 144(4): 496-503.

19. Detsky AS, Baker JP, O'Rourke K, et al. Predicting Nutrition-Associated Complica-tions for Patients Undergoing Gastroint-estinal Surgery. Journal of Parenteral and Enteral Nutrition 1987; 11: 440-6.

20. JONES CM. POSTOPERATIVE NUTRITIONAL EDEMA. Archives of Surgery 1933; 27: 159.

21. Mullen JL. Consequences of Malnutrition in the Surgical Patient. Surgical Clinics of North America 1981; 61: 465-87.

22. Rich MW, Keller AJ, Schechtman KB, Marshall WG, Kouchoukos NT. Increased complications and prolonged hospital stay in elderly cardiac surgical patients with low serum albumin. The American Journal of Cardiology 1989; 63: 714-8.

23. Engelman DT, Adams DH, Byrne JG, et al. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery 1999;118:866-73.

24. Lee DH, Kim SY, Nam SY, Choi S-H, Choi JW, Roh J-L. Risk factors of surgical site infection in patients undergoing major oncological surgery for head and neck cancer. Oral Oncology 2011; 47: 528-31.

25. Olsen MA, Lock-Buckley P, Hopkins D, Polish LB, Sundt TM, Fraser VJ. The risk factors for deep and superficial chest surgical-site infections after coronary artery bypass graft surgery are different. The Journal of thoracic and cardiova-scular surgery 2002; 124(1): 136-45.

26. Lu JCY, Grayson AD, Jha P, Srinivasan AK, Fabri BM. Risk factors for sternal wound infection and mid-term survival following coronary artery bypass surgery. European Journal of Cardio-Thoracic Surgery 2003; 23: 943-9.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles