869 Relations between changes in nutritional status and postoperative infection in patients who undergo gastric surgery

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Haruko Takasaki, RN, MSN , St. Marianna Medical University Hospital, International University of Health and Welfare Graduate School, Kanagawa Pref., Japan
Hanako Misao, RN, PhD. , International University of Health and Welfare, Graduate School, Kanagawa prefecture, Japan
Background: The definition of postoperative infections(PIs)  is a general term for infectious complications after surgery, which include infections incurred from surgery (SSIs) as well as postoperative complications which lead to infections (SPIs). From the extant research, there are statistically significant relations between preoperative patient’s nutritional status and their postoperative rate of infections. Several studies use albumin as an evaluation indicator. However, it is uncertain whether using both preoperative and postoperative nutritional changes in albumin(ALB) levels in the body, thereby tracking the half-life of ALB over a 3 week period, or simply using preoperative nutritional analysis as an indicator for postoperative infection’s risk factors, is the most effective indicator of infections.
Objective: The objective of this study is to quantify the occurrence of PIs and the changes in perioperative and postoperative nutritional status.
Methods: Prospective cohort study was performed with 89 patients undergoing gastric surgery, who were followed for 30 days after the surgery. Collected data was as follows: nutritional assessment (subjective global assessment: SGA, height, weight, ALB, Pre-Albmin(PA) and other blood results); PIs; and others.
This study was conducted under the approval of the ethical committee of the researchers’ graduate school as well as the ethics committee in 3 different hospitals where the data collection was conducted.
Results: The incidence of PIs occurred in 12 out of 89 (13.5%) subjects, with 7 patients (7.9%) having SSI and 6 patients (6.7%) having SPI. There was also a positive relation between objective nutritional indicators including serum albumin and other test results from the statistical study. Insignificant statistical differences were seen through preoperative nutritional conditions in both PI and non-PI groups. For subjects in PI group, their energy intake was low on day 4 and the PA levels showed declension compared with those in non-PI group. Also, the result shows that if the level of ALB decreases by more than 24% and/or the level of PA decreases by more than 50%, the risk for the incidence of PI would increase at a rate significantly higher than other categories.
Conclusions: From the findings, it is important to sustain essential energy intake on postoperative day 4. Also, nursing intervention in nutritional assessment and increase oral intake are necessary.

Since the most extant research paper have examined the relationship using the preoperative or postoperative point of measurement only, and have not reported the cutoff point for postoperative changes of nutritional status among the patients who undergo gastric surgery, the findings of this study, using two points of measurement of changes of the nutritional status, might contribute to the quality of postoperative care in order to reduce PIs.