What is the clinical evidence from this study?

Study design: Observational. Population: Pancreatic cancer / Patients undergoing Whipple surgery (n=23808). Intervention: Pre-operative serum albumin < 3.73 g/L vs. Pre-operative serum albumin ≥ 3.73 g/L. Primary outcome: Superficial and deep surgical site infections (S/D SSI) within 30 days post-surgery (OR 1.14, 95% CI 1.05-1.24, p=0.002).

November 10, 2022Scientific Reports17 citationsOpen Access

The role of preoperative albumin and white blood cell count in surgical site infections following whipple surgery

Q: What are the key findings of this study?

Pre-operative serum albumin lower than 3.73 g/L was significantly associated with a 14% increased odds of developing superficial and deep surgical site infections following Whipple surgery (OR 1.14).

MTMohamad Ali TfailyEmory University PGPaola GhanemJohns Hopkins University SFSarah H. FarranUniversity of Michigan

Key Result

Pre-operative serum albumin lower than 3.73 g/L was significantly associated with a 14% increased odds of developing superficial and deep surgical site infections following Whipple surgery (OR 1.14).

Study Design

Type

Observational (n=23,808)

Multicenter

Yes

Structured PICO

Does pre-operative hypoalbuminemia or elevated WBC count predict surgical site infections in patients undergoing Whipple surgery?

Population

23,808 adults undergoing total or partial pancreaticoduodenectomy, followed for 30 days post-surgery to assess the incidence of surgical site infections.

Exposure

Pre-operative serum albumin < 3.73 g/L and pre-operative white blood cell (WBC) count

Comparator

Pre-operative serum albumin ≥ 3.73 g/L and lower WBC count

Outcome

Superficial and deep surgical site infections (S/D SSI) and organ-space SSI occurring within 30 days post-surgical procedurehard clinical

Pre-operative hypoalbuminemia is associated with an increased risk of superficial and deep surgical site infections, while elevated WBC count is associated with organ-space infections following Whipple surgery.

Main Result

Odds Ratio: 1.14 (95% CI 1.05–1.24)

p-value: p=0.002

Limitations

The dataset lacks data relevant to pancreatic surgery including chemotherapy/radiotherapy administration, pre-operative cholangitis and preoperative biliary stenting.
The appropriateness of preoperative prophylactic antibiotics is a crucial confounder that is not provided by NSQIP.
The database depends on the nature and comprehensiveness of data provision by each institution.
Missing values were assumed to be missing at random and imputed.
Dataset lacks data relevant to pancreatic surgery including chemotherapy/radiotherapy administration, pre-operative cholangitis, and preoperative biliary stenting
Lack of data on the appropriateness of preoperative prophylactic antibiotics
Dependence on the nature and comprehensiveness of data provision by each institution
Missing data requiring imputation
Potential survival bias (collider bias) for smoking

Abstract

Whipple surgery is associated with a high risk of surgical sites infections (SSIs). Nutritional deficiency has been associated with an increased risk of wound infections. This study aims at exploring the role of preoperative albumin levels in predicting the risk of SSIs following Whipple surgery. A total of 23,808 individuals were identified from the ACS-NSQIP database from years 2011 to 2017. The primary exposure was pre-operative albumin while the secondary exposure was white blood cell (WBC) count. The primary outcome was divided into superficial and deep surgical site infections (S/D SSI) and organ-space SSI. All statistical analyses were conducted using IBM Statistical Package for Social Sciences version 26. Levels of pre-operative serum albumin less than 3.73 g/L, dirty and contaminated wounds and longer operative time were associated with increased odds for developing S/D SSIs (OR = 1.14, OR = 1.17, OR = 1.06, respectively, p-value < 0.05). Pre-operative WBC level (/L) was associated with a risk of developing an organ-space SSI but not S/D SSI (OR = 1.02, p-value 0.003). This study demonstrates the predictive role of pre-operative albumin in developing S/D SSIs and highlights the need to develop therapeutic strategies to optimize the pre-operative nutritional health status of patients undergoing Whipple surgery.

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Cite This Study

Tfaily et al. (2022) führten eine Beobachtungsstudie bei Patienten mit Bauchspeicheldrüsenkrebs durch, die sich einer Whipple-Operation unterzogen (n=23.808). Präoperatives Serumalbumin < 3,73 g/L vs. Präoperatives Serumalbumin ≥ 3,73 g/L wurde hinsichtlich oberflächlicher und tiefer chirurgischer Stelleninfektionen (S/D SSI) innerhalb von 30 Tagen nach der Operation bewertet (OR 1,14, 95 % CI 1,05-1,24, p=0,002). Ein präoperatives Serumalbumin von weniger als 3,73 g/L war signifikant mit einer um 14 % erhöhten Wahrscheinlichkeit für die Entwicklung oberflächlicher und tiefer chirurgischer Stelleninfektionen nach einer Whipple-Operation assoziiert (OR 1,14).

synapsesocial.com/papers/6a20dc0b920f77b2c049d2da https://doi.org/10.1038/s41598-022-21849-2

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