Title: Hypoalbuminemia is an Important Risk Factor for Surgical Wound Healing

Authors: Dr Harekrishna Majhi, Dr Pramit Ballav Panigrahi, Dr Abinasha Mohapatra, Srimanta Mahapatra

 DOI: https://dx.doi.org/10.18535/jmscr/v7i11.160

Abstract

Introduction: This retrospective study used serum albumin as the only indicator of nutritional status for patients who are admitted for elective or emergency surgery. Serum albumin level is affected by insulin, thyroid hormones, inflammatory cytokines, hypermetabolism, malabsorption, intravascular volume overload. If the deficit factors could be identified and corrected in pre-operative period, the chances of wound healing related complications (like wound infection, wound dehiscence, and anastomotic leak) will be reduced.

Aim: To study effect of serum albumin level in abdominal wound healing and related complications like wound infection, wound dehiscence and anastomotic leak.

Materials and Methods: The study is conducted in surgery department, V.S.S. institute of medical science and research, Sambalpur, Odisha.  A total of 150 patients were studied over a period of 5 months and were evaluated for serum albumin and the wound related complications.

Results: Hypoalbuminemics are more prone to develop wound related complications than normoalbuminemics.

Conclusion: Serum albumin levels can be considered to be one of the best predictors for the wound related complications.

References

  1. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative Serum Albumin level as a predictor of operative mortality and morbidity. Arch Surg 1999; 134:36-42.
  2. Heys SD, Simpson WG, Eremin O. Surgical nutrition. In: Paterson-Brown S, editor. Emergency surgery and critical care. 7th ed. London: WB Saunders, 1997; 55.
  3. Williams JZ, Barbul A. Nutrition and wound healing. Surg Clin North Am 2003; 83:571.
  4. Vincent JL, Dubois MJ, Navicks RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? Ann Surg, 2003; 237:319-334.
  5. Golub R, Sorrento JJ Jr, Cantu R Jr. Efficacy of albumin supplementation in the surgical intensive care unit: a prospective, randomized study. Crit Care Med 1997; 25: 249-252.
  6. Wojtsjak SL, Brown RO, Roberson D. Effect of Hypoalbuminemia and parenteral nutrition on free water excretion and electrolyte-free water resorption. Crit Care Med 1992; 20:164-169.
  7. Brown RO, Bradley JE, Bekemeyer WB. Effect of albumin supplementation during parenteral nutrition on hospital morbidity. Crit Care Med 1988; 16:1177-1182.
  8. Mullen JL, Buzby GP, Waldman MT, Gertner MH, Hobbs CL, Rosato EF. Prediction of operative morbidity and mortality by preperative nutritional assessment. Surg Forum 1979; 30:80-82.
  9. Nagachinta T, Stephens M, Reitz B. Risk factors for surgical wound infection following cardiac surgery. J Infect Dis 1957; 156: 967.
  10. Foley EF, Borlase BC, Dzik WH. Albummin supplementation in the critically ill. A prospective, randomized trial. Arch Surg. 1990; 125:739-742.
  11. Ryan JA, Taft DA. Preoperative nutritional assessmentdoes not predict morbidity and mortality in abdominal operations. Surg Forum 1980; 31:9698.
  12. Gherini S, Vaughn BK, Lombardi AV Jr, Mallory TH. Delayed wound healing and nutritional deficiencies after total hip arthroplasty. Clin Orthop Relat Res, 1993; 293:188-195.
  13. Engleman DT, Adams DH, Byrne JG, Avanki SF, Collins JJ, Couper GS et al. Impact of BMI and Serum Albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovas Surg, 1999; 118: 866-873.
  14. Joshi J, Shvkumaran S, Bhargav Y, Kansare B, Sharma RS. Perioperative management of the Geriatric patient. J Ind Aca Geri, 2006; 2:28-33.
  15. Mullen JT, Davenport DL, Hutter MM, Hosokawa PW, Henderson WG, Khuri SF et al. Impact of BMI on perioperative outcome in patients undergoing major intra abdominal cancer surgery. Ann Surg Onco, 2008; 15:2164-2172.
  16. Fuhrman MP ; The albumin nutrition concentration : separating myth from fact . Nutrition 18 : 199- 200, 2002

Corresponding Author

Dr Harekrishna Majhi

Associate Professor, Department of Surgery, Veer Surrendra Sai Institute of Medical Science and Research, Burla,Odish, India,768017