Nutrition and Surgical Site Infections: Study

As reported by Susan M. Rapp for Healio, spine surgery patients at the University of Pittsburgh Medical Center (UPMC) who had impaired preoperative nutrition based on levels of prealbumin less than 20 mg/dL had an increased risk of developing a surgical site infection, according to McGowan Institute for Regenerative Medicine affiliated faculty member David Okonkwo, MD, PhD, at Spine Summit 2016: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting.

Dr. Okonkwo, Professor and Executive Vice Chair of Neurological Surgery, University of Pittsburgh, Professor of Sports Medicine and Nutrition, Director of Neurotrauma and of the Scoliosis and Spinal Deformity Program at UPMC, and Clinical Director of the Brain Trauma Research Center, and colleagues prospectively followed 622 patients in a registry who underwent spine surgery between October 2009 and December 2014 at UPMC. They performed a linear regression analysis to look at the relationship of the patients’ prealbumin level to whether they developed a surgical site infection (SSI).

An earlier retrospective study the investigators conducted showed prealbumin less than 20 mg/dL and a diagnosis of diabetes mellitus were associated with an increased risk of SSI, Dr. Okonkwo said.

“In this prospective study, diabetes mellitus dropped out and a prealbumin of less than 20 remained the sole predictive factor with a hazard ratio of 4.95 of predicting risk for the development of a SSI with a very strong P value,” he said.

The patients, who were tracked with standardized outcome measures, underwent various types of spine surgery. For the analysis, however, cases of deformity correction were excluded, as were lateral interbody fusions, discectomies, and anterior cervical discectomy and fusion.

As for the exclusions, “deformity has an outlier of SSI rates and these others are clearly at a lower risk,” Dr. Okonkwo said.

“We went from retrospective prealbumins at the time of the infection to retrospective of prealbumins taken in the month prior to surgery, to a prospective evaluation of what is the relationship between preoperative nutritional status and SSI. This relationship is born out every single time, which is why we are now developing an intervention program for at-risk patients with poor nutrition profiles to encourage and facilitate a further reduction of the infection rate at our institution,” Dr. Okonkwo said.