ORIGINAL ARTICLE   

Chirurgia 2019 February;32(1):13-7

DOI: 10.23736/S0394-9508.18.04848-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Preoperative prognostic nutritional index is a strong predictor of surgical site infection after surgery for colorectal perforation

Masahide IKEGUCHI ✉, Sho-Ichi URUSHIBARA, Kanenori ENDO, Seiichi NAKAMURA

Department of Surgery, Tottori Prefectural Central Hospital, Tottori, Japan

BACKGROUND: Emergency surgery is necessary in patients with colorectal perforation. However, postoperative surgical site infection (SSI) is one of the most common hospital-acquired complications in these patients. In the present study, we retrospectively analyzed the correlation between the preoperative prognostic nutritional index (PNI) and the occurrence of postoperative SSI in patients with colorectal perforation.
METHODS: From 2006 to 2017, emergency surgery was performed in 54 patients with colorectal perforation in our institute. Patients with a perforated appendix related to appendicitis or with intestinal obstruction due to colorectal malignancies were excluded. Seven factors, (age, American Society of Anesthesiologists score, location of perforation, time from onset of symptoms to surgery, operation time, preoperative neutrophil/lymphocyte ratio, and PNI) that may influence the occurrence of postoperative SSI were analyzed by logistic regression.
RESULTS: Two patients died of SSI within 30 days after surgery (10 and 14 days). SSIs were detected in 30 patients (30/54, 55.6%, superficial and deep, N. = 12; organ or space, N. = 18). Among the seven factors, only PNI was proven to be an extremely strong risk factor for postoperative SSIs. In 51 surviving patients, a strong negative correlation between the postoperative hospital stay and preoperative PNI was observed (ρ = -0.504, P<0.001).
CONCLUSIONS: In patients with colorectal perforation and a low preoperative PNI, special attention is required to prevent the occurrence of SSI.

KEY WORDS: Intestinal perforation - Postoperative period - Nutrition assessment - Surgical wound infection