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Surgical site infection (SSI) is a hospital-acquired infection (HAI) associated with increased mortality, length of hospital stay, and cost of hospitalization. The aim of this study was to identify the value of albumin as an indicator of the nutritional status, postoperative C-reactive protein (CRP), and white blood cell (WBC) levels in predicting an outbreak of SSI and SSI-related epidemiology after colorectal surgery and identifying the risk factors for SSI.
A total of 198 patients, who underwent colorectal surgery from September 1, 2015 to December 31, 2016, were included in the study. The patient identity, operation characteristics, and SSI data were analyzed retrospectively by a chart review and national SSI reporting sheet. The relationship of the SSI and clinical data was analyzed statistically, and the SSI detection time and post-operative inflammatory laboratory findings were analyzed individually using cumulative incidence analysis and cause-specific hazard model.
The incidence of SSI post colorectal surgery was 15.7% (31 out of 198 cases). Chronic renal failure (CRF), open surgery, long operation time, and stoma were identified as significant risk factors for SSI using univariate analysis. The CRF, long operation time, and stoma were significant risk factors according to multivariate analysis. The decrease in albumin on post-operative day (POD)#3 and CRP elevation on POD#4 were related to the early detection of SSI.
The actual incidence of SSI might be higher than expected, particularly in cases where patients have several clinical and operative factors. In addition, the albumin level and multiple postoperative inflammation tests can be employed as an early predictors of SSI.
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Enteral feeding is strongly recommended for critically ill patients since it can enhance the immunologic function, which serves as a host defense mechanism against inflammation or metabolic response to stress. Herein, we investigated nutritional status and estimated the adequacy of the nutritional supply for acutely ill patients admitted to the surgical intensive care unit (SICU) after a major operation.
From February to October 2016, patients admitted and stayed over 48 hours after major surgical procedures at SICU in Seoul St. Mary’s Hospital were reviewed. The nutritional parameters and surgical outcomes were compared according to the status of nutritional support.
A total of 220 patients composed of 130 males (59.1%) and 90 females (40.9%) were enrolled, and mean age was 61.4±13.6 years. All patients were classified into two groups according to nutritional status, which was assessed by the ratio of total delivered calories to total required calories (D/R); group A (54 cases, 24.5%, D/R≥0.7) versus group B (166 cases, 75.5%, D/R<0.7). In multivariate analysis, incision in the lower abdomen (Odds Ratio 2.277, P=0.078), absence of NST consultation (Odds Ratio 2.728, P=0.011), and not receive minimal invasive surgery (Odds Ratio 3.518, P=0.001) were independent risk factors associated with poor nutritional status.
Clinicians should pay more attention to patients who had an incision in the lower abdomen or did not receive minimal invasive surgery or NST consultation, which would be predisposing factors for nutritional insufficiency resulting in postoperative morbidities.
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