CORRELATION OF IMMUNE AND NUTRITIONAL-STATUS WITH WOUND COMPLICATIONS IN PATIENTS UNDERGOING VASCULAR OPERATIONS

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  • 1 January 1983
    • journal article
    • research article
    • Vol. 93  (6) , 822-827
Abstract
The acquired failure of host immunocompetence that may result from significant protein and caloric malnutrition is associated with an increased incidence of septic complications in patients undergoing operation. Wound infection in patients undergoing vascular surgical procedures may lead to exposure or contamination of a vascular graft, with the subsequent risk of hemorrhage, limb loss or death. A study was undertaken to correlate the immune and nutritional status of patients undergoing vascular surgical procedures with the development of significant wound complications. Patients (79) undergoing a variety of vascular operations were subjected to comprehensive nutritional assessment, including anthropometric measurements (height, weight, midarm circumference, triceps skin fold), serologic testing (albumin, transferrin, lymphocyte count, serum Zn), cutaneous assessment of delayed hypersensitivity (anergy battery) and neutrophil functional analysis. After operation the patients were observed for the development of delayed wound healing or wound infection. Statistical analysis of measured variables was performed to identify immune and nutritional markers with prognostic value. Patients with serum albumin levels > 3 g/dl were much more likely to have uncomplicated wound healing (P < 0.001). Patients with serum transferrin levels above 150 mg/dl had significantly fewer wound problems (P < 0.01). Only 29% of patients with cutaneous anergy had normal wound healing, while 56% of those with intact cutaneous reactivity healed primarily; this difference was not statistically significant. Diabetics in this series were more likely to develop wound problems (P < 0.05). Anthropometric measurements provided no predictive information regarding the likelihood of uncomplicated healing. Measurement of total lymphocyte count and serum Zn yielded no significant prognostic information. The urgent nature of many vascular surgical procedures may preclude preoperative immune and nutritional assessment; the outcome of these procedures may ultimately depend upon intact host defense. The contribution of protein and caloric malnutrition to immunocompromise can be easily assessed in these patients. The detection and subsequent reversal of immunoincompetence through the use of enteral or parenteral alimentation should provide a significant reduction in operative morbidity and mortality.