title: Nutritional status as a predictive marker for surgical site infection in total joint arthroplasty.
abstract: BACKGROUND
  Surgical site infection (SSI) is considered one of the most serious complications in total joint arthroplasty (TJA). This study seeks to analyze the predictive value of preoperative and postoperative nutritional biomarkers for SSI in elective TJA.
  
  
  METHODS
  Nutritional markers were gathered retrospectively utilizing patient's records from the orthopedics department at Benghazi Medical Center (BMC). The sample spanned cases admitted during the 20-month period between January 2012 and August 2013 and had undergone either elective total hip replacement or total knee replacement. The collected lab results included a complete blood count, total lymphocyte count (TLC), and serum albumin (S. alb.) levels. The patients were then divided into two groups based on the occurrence of an SSI.
  
  
  RESULTS
  A total of 135 total knee (81.5%, n = 110/135) and total hip (18.5%, n = 25/135) replacements were performed at BMC during the study period. Among these cases, 57% (n = 78/135) had patient records suitable for statistical analysis. The average preoperative TLC was 2.422 ×10(3) cells/mm(3) (range = 0.8-4.7 ×10(3) cells/mm(3)) whereas that number dropped after the surgery to 1.694 ×10(3) cells/mm(3) (range = 0.6-3.8 ×10(3) cells/mm(3)). S. alb. levels showed a mean of 3.973 g/dl (range = 2.9-4.7 g/dl) preoperatively and 3.145 g/dl (range = 1.0-4.1 g/dl) postoperatively. The majority of TJA patients did not suffer any complication (67.4%, n = 91/135) while eight cases (5.9%) suffered from a superficial SSI.
  
  
  CONCLUSIONS
  Preoperative S. alb. was identified as the only significant predictor for SSI (P = 0.011). Being a preventable cause of postoperative morbidity, it is recommended that the nutritional status (especially preoperative S. alb.) of TJA patients be used as a screening agent and appropriate measures be taken to avoid SSI.
authors.affiliation: Department of Orthopedic Surgery, Benghazi Medical Center, Libyan International Medical University, Benghazi, Libya.
authors.forename: Randa
authors.initials: R
authors.lastname: Alfargieny
authors.affiliation: Department of Medicine, Faculty of Medicine, Libyan International Medical University, Benghazi, Libya.
authors.forename: Zuhir
authors.initials: Z
authors.lastname: Bodalal
authors.affiliation: Department of Oncology, University Hospital Sharjah, Sharjah, UAE.
authors.forename: Riyad
authors.initials: R
authors.lastname: Bendardaf
authors.affiliation: Department of Orthopedic Surgery, Benghazi Medical Center, Libyan International Medical University, Benghazi, Libya.
authors.forename: Mustafa
authors.initials: M
authors.lastname: El-Fadli
authors.affiliation: Department of Orthopedic Surgery, Benghazi Medical Center, Libyan International Medical University, Benghazi, Libya.
authors.forename: Salem
authors.initials: S
authors.lastname: Langhi
keywords: Libya; nutrition; serum albumin; surgical site infection; total joint arthroplasty; total lymphocyte count