Midwestern Vascular Surgical Society| Volume 93, ISSUE 6, P822-827, June 1983

Download started.


Correlation of immune and nutritional status with wound complications in patients undergoing vascular operations

      This paper is only available as a PDF. To read, Please Download here.


      The acquired failure of host immunocompetence that may result from significant protein and caloric malnutrition has been 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. The present study was undertaken to correlate the immune and nutritional status of patients undergoing vascular surgical procedures with the development of significant wound complications. Seventy-nine patients 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 zinc), 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 above 3 gm/dl were much more likely to have uncomplicated wound healing (P < 0.001). Similarly, 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, however, 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. Similarly, measurement of total lymphocyte count and serum zinc yielded no significant prognostic information. The urgent nature of many vascular surgical procedures may preclude preoperative immune and nutritional assessment; however, 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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bagdade JD
        • Root RK
        • Bulger RJ
        Impaired leukocyte function in patients with poorly controlled diabetes.
        Diabetes. 1974; 23: 9-14
        • Bistrian BR
        Assessment of protein energy malnutrition in surgical patients.
        in: Hill GL Nutrition and the surgical patient. Churchill Livingstone, New York1981
        • Bistrian BR
        • Blackburn GL
        • Scrimshaw NS
        • Flatt JP
        Cellular immunity in semi-starved states in hospitalized patients.
        Am J Clin Nutr. 1975; 28: 1148-1155
        • Collins JP
        • MacCarthy ID
        • Hill GL
        Assessment of protein nutrition in surgical patients—The value of anthropometrics.
        Am J Clin Nutr. 1979; 32: 1527-1530
        • Forse RA
        • Shizgal HM
        The assessment of malnutrition.
        Surgery. 1980; 88: 17-24
        • Hickman DM
        • Miller RA
        • Rombeau JL
        • Frey CF
        Serum albumin and body weight as predictors of postoperative course in colorectal cancer.
        J Parent Ent Nutr. 1980; 4: 314-316
        • Kaminski MV
        • Fitzgerald MJ
        • Murphy RJ
        • Pagast P
        • Hoppe MC
        • Winborn AL
        • Pluta J
        Correlation of mortality with serum transferrin and anergy.
        J Parent Ent Nutr. 1977; 1: 27-31
        • Keane RM
        • Munster AM
        • Birmingham W
        • Winchurch RA
        • Gadacz TR
        • Ernst CB
        Suppression of lymphocyte function after aortic reconstruction.
        Arch Surg. 1982; 117: 1133-1136
        • Law DK
        • Dudrick SJ
        • Abdou NI
        Immunocompetence of patients with protein calorie malnutrition.
        Ann Intern Med. 1973; 79: 545-550
        • Meakins JL
        • Christou NV
        • Shizgal HM
        • MacLean LD
        Therapeutic approaches to anergy in surgical patients.
        Ann Surg. 1979; 190: 286-295
        • Meakins JL
        • McClean APH
        • Kelly R
        • Bubenick O
        • Pietsch JB
        • MacLean LD
        Delayed hypersensitivity and neutrophil chemotaxis: Effects of trauma.
        J Trauma. 1978; 18: 240-247
        • Mullen JL
        • Gertner MH
        • Buzby GP
        • Goodhart GL
        • Rosato EF
        Implications of malnutrition in the surgical patient.
        Arch Surg. 1979; 114: 121-125
        • Mullin TJ
        • Kirkpatrick JR
        The effect of nutritional support on immune competency in surgical patients suffering from trauma, sepsis, or malignant disease.
        Surgery. 1981; 90: 610-615
        • Pietsch JB
        • Meakins JL
        • Gotto D
        • MacLean LD
        Delayed hypersensitivity response: The effect of surgery.
        J Surg Res. 1977; 22: 228-230
        • Pietsch JB
        • Meakins JL
        • MacLean LD
        The delayed hypersensitivity response: Applications in clinical surgery.
        Surgery. 1977; 82: 349-355
        • Rhoads JE
        • Alexander CE
        Nutritional problems of surgical patients.
        Ann NY Acad Sci. 1955; 63: 268-275
        • Seltzer MH
        • Bastidan JA
        • Cooper DM
        • Engler P
        • Slocum B
        • Fletcher HS
        Instant nutritional assessment.
        J Parent Ent Nutr. 1979; 3: 157-159
        • Shaver HJ
        • Loper JA
        • Lutes R
        Nutritional status of a nursing home population (abstract).
        J Parent Ent Nutr. 1980; PS42: 81
        • Shizgal HM
        • Forse RA
        • Spanier AH
        • MacLean LD
        Protein malnutrition following intestinal bypass for morbid obesity.
        Surgery. 1979; 86: 60-63
        • Tan JS
        • Watanakunakorn C
        • Phair JP
        A modified assay of neutrophil function: Use of lysostaphin to differentiate defective phagocytosis from impaired intracellular killing.
        J Lab Clin Med. 1971; 78: 316-319
        • van Dijk WC
        • Verbrugh HA
        • van Rijswijik REN
        • Vos A
        • Verhoef J
        Neutrophil function, serum opsonic activity, and delayed hypersensitivity in surgical patients.
        Surgery. 1982; 92: 21-29
        • Wannemacher RW
        Protein metabolism.
        in: Ghadini H Protein metabolism in total parenteral nutrition. John Wiley & Sons, New York1973: 85-153
        • Weinsier RL
        • Hunker EM
        • Krumdieck CL
        • Butterworth CE
        Hospital malnutrition: A prospective evaluation of general medicine patients during the course of hospitalizalion.
        Am J Clin Nutr. 1979; 32: 418-426