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Abstract
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.
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Article info
Footnotes
☆Presented at the Sixth Annual Meeting of the Midwestern Vascular Surgical Society, Milwaukee, Wis., Sept. 24–25, 1982.
☆☆Supported in part by the Northwestern Vascular Foundation.
★Their service was invaluable in the collection of patient data and in the management of several difficult clinical problems.
Identification
Copyright
© 1983 Published by Elsevier Inc.
