A positive association between nutritional risk and the incidence of surgical site infections: A hospital-based register study

Abstract

Surgical site infections (SSI) are amongst the most common health care-associated infections and have adverse effects for patient health and for hospital resources. Although surgery guidelines recognize poor nutritional status to be a risk factor for SSI, they do not tell how to identify this condition. The screening tool Nutritional Risk Screening 2002 is commonly used at hospitals to identify patients at nutritional risk. We investigated the association between nutritional risk and the incidence of SSI among 1194 surgical patients at Haukeland University Hospital (Bergen, Norway). This current study combines data from two mandatory hospital-based registers: a) the incidence of SSI within 30 days after surgery, and b) the point-prevalence of patients at nutritional risk. Patients with more than 30 days between surgery and nutritional risk screening were excluded. Associations were assessed using logistic regression, and the adjusted odds ratio included age (continuous), gender (male/female), type of surgery (acute/elective) and score from The American Society of Anesthesiologists Physical Status Classification System. There was a significant higher incidence of SSI among patients at nutritional risk (11.8%), as compared to those who were not (7.0%) (p = 0.047). Moreover, the incidence of SSI was positively associated with the prevalence of nutritional risk in both simple (OR 1.76 (95% CI: 1.04, 2.98)) and adjusted (OR 1.81 (95% CI: 1.04, 3.16)) models. Answering “yes” to the screening questions regarding reduced dietary intake and weight loss was significantly associated with the incidence of SSI (respectively OR 2.66 (95% CI: 1.59, 4.45) and OR 2.15 (95% CI: 1.23, 3.76)). In conclusion, we demonstrate SSI to occur more often among patients at nutritional risk as compared to those who are not at nutritional risk. Future studies should investigate interventions to prevent both SSI and nutritional risk among surgical patients.

Patients’ and healthcare workers’ recommendations for a surgical patient safety checklist – a qualitative study

“…Other studies on alcohol misuse and nutritional status have also found fewer complications if these issues are addressed six to eight weeks before surgery [6,33]. Screening for multiresistant bacteria, quitting smoking, treatment of chronic diseases, nutritional status, perioperative showering and body temperature and wound care after surgery are other risk elements we found, which is in line with today's recommended key actions for patients to help prevent surgical site infections [34,35]. Patient checklists containing elements taking into account such factors could be of great benefit.…”

Weight loss and BMI criteria in GLIM's definition of malnutrition is associated with postoperative complications following abdominal resections – Results from a National Quality Registry

“…Hospitalized patients with weight loss have previously been demonstrated to have an increased risk for both morbidity and mortality the following year [1,3,4,7,22], as compared to patients not having weight loss. In the present study, any preoperative weight loss had a statistically significant association with severe surgical complications, whereas the WHO's definition of underweight did not.…”

Antimicrobial coating of spider silk to prevent bacterial attachment on silk surgical sutures

“…More than 20% of nosocomial infections are related to surgical site infections (SSI) [3,4]. These SSI represent a heavy economic burden to the healthcare systems with an estimated cost of €325 per day in Europe or €22,401 per infection in the United States [5,6] due to additional post-operative surgery and longer patient hospitalization [7].…”