Low Albumin Held Risk for Surgical Site Infection

CINCINNATI — Surgical site infections found in deep wounds or in organs or spaces manipulated during an operation might occur more often after general surgical procedures if patients have low blood albumin or are operated on through a previous incision, according to the results of a case-control study.

These new risk factors for surgical site infection (SSI) join old suspects—such as prolonged operative time and chronic obstructive pulmonary disease (COPD)—as independent predictors of any kind of SSI, according to a study presented by Dr. Manjunath Haridas at the annual meeting of the Central Surgical Association.

The risk factors should guide clinicians in their assessment of SSI risk and identify potential targets for intervention to reduce their incidence, said Dr. Haridas, a resident in the department of surgery at Case Western Reserve University, Cleveland.

During 2000–2006, 316 SSIs occurred in 10,253 general surgical procedures performed at one center. Dr. Haridas and his coinvestigator at Case Western, Dr. Mark Malangoni, compared 300 of these patients with SSIs with 300 matched control patients who also underwent surgery but did not develop an SSI (16 patients were excluded because no suitable matches could be found).

The patients, whose mean age was 56 years, underwent operations for the gastrointestinal tract, including the hepatobiliary system and pancreas (39% of patients); hernia repair (19%); and vascular (16%), breast (13%), and extra-abdominal areas (13%). They developed superficial (84%), deep (7%), or organ/space infections (9%).

Multivariate logistic regression revealed that reoperation through a previous incision was independently associated with 2.4-times higher odds of developing an SSI, whereas a prolonged operation (surgery time greater than the 75th percentile), a blood albumin level of 3.4 mg/dL or less, and COPD each were independently associated with 70%–80% greater odds of developing an SSI.

Patients who had either low blood albumin or a reoperation through a previous incision were between two and three times more likely to develop a deep or organ/space SSI than were those in which neither condition occurred.

It might be a good idea to take a postoperative surgical time-out to “reassess where you have been”; if more blood was lost or the operation took longer than expected, it could be worth keeping a closer eye on the patient, said Dr. Hiram C. Polk of the University of Louisville (Ky.), a discussant at the meeting.

Although the investigators did not record how many SSIs occurred in previously operated wounds that also had previously had an SSI, Dr. Malangoni thought that reoperation through a previously infected wound incision should be avoided because of the likelihood of reinfection after the second operation.

The investigators did not determine the rate of SSI in minimally invasive surgical procedures, but they did match patients with an SSI who underwent such procedures with those who did not have an SSI after a minimally invasive surgical approach. There did not appear to be a decrease in deep or organ/space SSIs with minimally invasive approaches.

CINCINNATI — Surgical site infections found in deep wounds or in organs or spaces manipulated during an operation might occur more often after general surgical procedures if patients have low blood albumin or are operated on through a previous incision, according to the results of a case-control study.

These new risk factors for surgical site infection (SSI) join old suspects—such as prolonged operative time and chronic obstructive pulmonary disease (COPD)—as independent predictors of any kind of SSI, according to a study presented by Dr. Manjunath Haridas at the annual meeting of the Central Surgical Association.

The risk factors should guide clinicians in their assessment of SSI risk and identify potential targets for intervention to reduce their incidence, said Dr. Haridas, a resident in the department of surgery at Case Western Reserve University, Cleveland.

During 2000–2006, 316 SSIs occurred in 10,253 general surgical procedures performed at one center. Dr. Haridas and his coinvestigator at Case Western, Dr. Mark Malangoni, compared 300 of these patients with SSIs with 300 matched control patients who also underwent surgery but did not develop an SSI (16 patients were excluded because no suitable matches could be found).

The patients, whose mean age was 56 years, underwent operations for the gastrointestinal tract, including the hepatobiliary system and pancreas (39% of patients); hernia repair (19%); and vascular (16%), breast (13%), and extra-abdominal areas (13%). They developed superficial (84%), deep (7%), or organ/space infections (9%).

Multivariate logistic regression revealed that reoperation through a previous incision was independently associated with 2.4-times higher odds of developing an SSI, whereas a prolonged operation (surgery time greater than the 75th percentile), a blood albumin level of 3.4 mg/dL or less, and COPD each were independently associated with 70%–80% greater odds of developing an SSI.

Patients who had either low blood albumin or a reoperation through a previous incision were between two and three times more likely to develop a deep or organ/space SSI than were those in which neither condition occurred.

It might be a good idea to take a postoperative surgical time-out to “reassess where you have been”; if more blood was lost or the operation took longer than expected, it could be worth keeping a closer eye on the patient, said Dr. Hiram C. Polk of the University of Louisville (Ky.), a discussant at the meeting.

Although the investigators did not record how many SSIs occurred in previously operated wounds that also had previously had an SSI, Dr. Malangoni thought that reoperation through a previously infected wound incision should be avoided because of the likelihood of reinfection after the second operation.

The investigators did not determine the rate of SSI in minimally invasive surgical procedures, but they did match patients with an SSI who underwent such procedures with those who did not have an SSI after a minimally invasive surgical approach. There did not appear to be a decrease in deep or organ/space SSIs with minimally invasive approaches.

CINCINNATI — Surgical site infections found in deep wounds or in organs or spaces manipulated during an operation might occur more often after general surgical procedures if patients have low blood albumin or are operated on through a previous incision, according to the results of a case-control study.

These new risk factors for surgical site infection (SSI) join old suspects—such as prolonged operative time and chronic obstructive pulmonary disease (COPD)—as independent predictors of any kind of SSI, according to a study presented by Dr. Manjunath Haridas at the annual meeting of the Central Surgical Association.

The risk factors should guide clinicians in their assessment of SSI risk and identify potential targets for intervention to reduce their incidence, said Dr. Haridas, a resident in the department of surgery at Case Western Reserve University, Cleveland.

During 2000–2006, 316 SSIs occurred in 10,253 general surgical procedures performed at one center. Dr. Haridas and his coinvestigator at Case Western, Dr. Mark Malangoni, compared 300 of these patients with SSIs with 300 matched control patients who also underwent surgery but did not develop an SSI (16 patients were excluded because no suitable matches could be found).

The patients, whose mean age was 56 years, underwent operations for the gastrointestinal tract, including the hepatobiliary system and pancreas (39% of patients); hernia repair (19%); and vascular (16%), breast (13%), and extra-abdominal areas (13%). They developed superficial (84%), deep (7%), or organ/space infections (9%).

Multivariate logistic regression revealed that reoperation through a previous incision was independently associated with 2.4-times higher odds of developing an SSI, whereas a prolonged operation (surgery time greater than the 75th percentile), a blood albumin level of 3.4 mg/dL or less, and COPD each were independently associated with 70%–80% greater odds of developing an SSI.

Patients who had either low blood albumin or a reoperation through a previous incision were between two and three times more likely to develop a deep or organ/space SSI than were those in which neither condition occurred.

It might be a good idea to take a postoperative surgical time-out to “reassess where you have been”; if more blood was lost or the operation took longer than expected, it could be worth keeping a closer eye on the patient, said Dr. Hiram C. Polk of the University of Louisville (Ky.), a discussant at the meeting.

Although the investigators did not record how many SSIs occurred in previously operated wounds that also had previously had an SSI, Dr. Malangoni thought that reoperation through a previously infected wound incision should be avoided because of the likelihood of reinfection after the second operation.

The investigators did not determine the rate of SSI in minimally invasive surgical procedures, but they did match patients with an SSI who underwent such procedures with those who did not have an SSI after a minimally invasive surgical approach. There did not appear to be a decrease in deep or organ/space SSIs with minimally invasive approaches.