Peripheral Vascular Surgery Society
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Peripheral Vascular Surgery Society |
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#10 DOES MALNUTRITION CONTRIBUTE TO POSTOPERATIVE MORBIDITY IN VASCULAR SURGICAL PATIENTS?
Marie T. Durkin, BSC, Kevin G. Mercer, Mary F. McNulty, Laura Phipp, Jane Upperton, Matthew Giles, DJA Scott St. James's Hospital Leeds, United Kingdom
Introduction: In an elderly population of surgical patients poor mobility, poor diet and chronic disease contribute to a significant risk of malnutrition. Malnutrition is associated with muscle weakness, fatigue, poor wound healing and immunological dysfunction.
Aim: The aim of the study is to establish the prevalence of malnutrition in vascular surgical patients and to compare postoperative infection rates in well-nourished and malnourished patients.
Patients and Methods: A nutritional assessment was performed on 71 patients (49 men; 22 women; median age 65 years; range 26-85 years) attending pre-assessment for vascular surgical procedures (23 femoro-distal bypass, 17 abdominal aortic aneurysms (AAA), 11 varicose veins, 8 carotid endarterectomies, 7 miscellaneous arterial and 4 cervical sympathectomies). Nutritional status was measured using validated indicators of malnutrition: Estimated weight changes over 3 months; body mass index (BMI) calculated from height and weight; midarm muscle circumference (MAMC) calculated using triceps skin fold thickness (TSF) and mid-arm circumference (MAC) (MAMC = MAC - (3.14 x TSF)); and serum albumin concentration. Fifty-nine patients were followed up after their vascular surgery. The incidence of postoperative infections was compared to their preoperative nutritional status.
Results: Nineteen patients (26.8%) had normal values for all five nutritional indicators. The remaining 52 patients (73.2%) had 1 (37), 2 (12), 3 (2), or 4 (1) nutritional indicators within the range for malnutrition. Of the 59 patients who underwent surgery, there were 5 chest infections, 7 wound infections, 1 UTI and 1 infected central line in 13 patients; 6 femoro-distal bypass, 4 AAA and 3 miscellaneous arterial procedures. The incidence of septic complications was 0% (0/14) in-patients with normal nutritional indicators and 40.6% (13/32) in patients with indicators of malnutrition (p<0.05%; Fisher's exact test).
Conclusion: Malnourished patients should be identified and referred to the dietician at the earliest opportunity to improve dietary intake to potentially reduce the morbid effects of undernutrition.
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Last updated January 10, 1999