title: Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study.
abstract: BACKGROUND
  Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly effects patient recovery and hospital resources.
  
  
  OBJECTIVE
  This study sought to determine the relationship between preoperative serum albumin and SSI.
  
  
  METHODS
  A study of 524 patients who underwent gastrointestinal surgery in 4 institutions was performed. Patients were identified using a prospective SSI database and hospital records. Serum albumin was determined preoperatively in all patients. Hypoalbuminemia was defined as albumin <30 mg/dL. Data are presented as median (interquartile range) and a difference between groups was examined using Mann-Whitney U and Fisher exact test and multiple logistic regression analysis.
  
  
  RESULTS
  A total of 105 patients developed a SSI (20%). The median time to the development of SSI was 7 (5-10) days. Having an emergency procedure (P = 0.003), having a procedure over 3 hours in duration (P = 0.047), being American Society of Anaesthetics grade 3 (P = 0.03) and not receiving preoperative antibiotics (P = 0.007) were associated with SSI while having a laparoscopic procedure reduced the likelihood of SSI (P = 0.004). Patients who developed a SSI had a lower preoperative serum albumin (30 [25-34.5] vs. 36 [32-39], P < 0.001). On multivariate analysis, hypoalbuminemia was an independent risk factor for SSI development (relative risk, RR = 5.68, 95% confidence interval: 3.45-9.35, P < 0.001). Albumin <30 mg/dL was associated with an increased rate of deep versus superficial SSI (P = 0.002). The duration of inpatient stay was negatively correlated with preoperative albumin (R = -0.319, P < 0.001).
  
  
  CONCLUSIONS
  Hypoalbuminemia is an independent risk factor for the development of SSI following gastrointestinal surgery and is associated with deeper SSI and prolonged inpatient stay.
authors.affiliation: Department of Surgery, Wexford General Hospital, Wexford, Ireland. derek.hennessey@gmail.com
authors.forename: Derek B
authors.initials: DB
authors.lastname: Hennessey
authors.forename: John P
authors.initials: JP
authors.lastname: Burke
authors.forename: Tara
authors.initials: T
authors.lastname: Ni-Dhonochu
authors.forename: Conor
authors.initials: C
authors.lastname: Shields
authors.forename: Desmond C
authors.initials: DC
authors.lastname: Winter
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mealy
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents