European Journal of Cardiovascular Medicine

Defined as infections occurring at or near surgical incision within 30 days of surgery or following one year if an implant is implanted, surgical site infections (SSI) seem to be related to the operative procedure. The surgical wound covers the entire operation site both inside and outside of the body. With 14–16% of all health care related infections among hospitalized patients, surgical site infections (SSI) ranks third most often reported infection.
Although malnutrition can cause major problems, as many as 50% of cases of pre-existing malnutrition go undetectable in the hospital population; a probable explanation is that visible symptoms of malnutrition only show in severe cases. Of brain, nerve cells, cell membranes, bile, which aids the body in absorbing fats and fat-soluble vitamins, cholesterol is a basic component. Serum albumin reflects nutritional state and is associated with beginning of surgical site infection; levels of cholesterol, its fractions (high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol [LDL-C]) also represent nutritional status. The most easily obtained and clinically valuable measure is the serum albumin level. Greater than 3.5 g/dl blood albumin levels indicate sufficient protein reserves and have a protective impact lowering the morbidity and SSI incidence risk. [1]

Study Design

This observational study was conducted over three months at tertiary care hospital central India, involving a total of 50 patients undergoing various surgical procedures. The study aimed to assess the incidence of surgical site infections (SSIs) and analyze associated risk factors.

Participants

The study included patients aged 18 years and above who were scheduled for elective or emergency surgical procedures. Informed consent was obtained from all participants prior to data collection.

Data Collection

Data were meticulously gathered from patient case files, which included:

Pre-operative Assessments

  - Cholesterol levels

  - Albumin levels

  - ASA (American Society of Anesthesiology) score

  - Demographic information (age, gender, comorbidities)

Peri-operative Details:

  - Type of surgery performed

  - Duration of surgery

  - Anesthesia type used

  - Intraoperative findings

Post-operative Outcomes:

• Monitoring for SSIs was conducted for a period of 30 days post-surgery.
• Any signs of infection were documented, including serous or purulent discharge from the surgical site, redness, and swelling.

Monitoring for Surgical Site Infections (SSIs)

Patients were monitored for the development of SSIs using the following criteria:

• Presence of purulent drainage from the wound
• Signs of inflammation (redness, heat, swelling)
• Wound dehiscence or the need for surgical re-intervention due to infection

Statistical Analysis

Data were analyzed using statistical software to determine the incidence of SSIs and evaluate potential risk factors. Descriptive statistics were employed to summarize patient demographics and clinical characteristics. The incidence rates of SSIs were calculated and compared against pre-defined benchmarks from existing literature.

Ethical Considerations

The study was approved by the institutional ethics committee, ensuring compliance with ethical standards for research involving human subjects. All patient information was kept confidential and used solely for research purposes.

Table 1: Sex Distribution of the Study

Table 1 illustrates the sex distribution of the study participants, comprising a total of 50 individuals. The majority of the participants are male, accounting for 35 individuals, which represents 70% of the study population. In contrast, female participants make up 30% of the group, totaling 15 individuals. This data indicates a higher representation of males compared to females in the study sample.

Table 2: Age Distribution of the Study

Table 2 presents the age distribution of the study participants, totaling 50 individuals. The largest age group is 21-40 years, comprising 28 participants, which accounts for 56% of the study population. This is followed by the 41-60 age group, with 18 participants representing 36%. The 61-80 age group includes 3 participants, making up 6% of the total, while the youngest age group, 00-20 years, consists of just 1 participant, accounting for 2%. This distribution shows a predominant representation of participants in the 21-40 age range.

Table 3: Distribution of Study Participants According to Total Cholesterol Levels

Table 3 shows the distribution of study participants based on their total cholesterol levels out of a total of 50 individuals. The majority of participants, 29 individuals (58%), have normal cholesterol levels. This is followed by 14 participants (28%) who have hypocholesterolemia, while 7 participants (14%) are identified with hypercholesterolemia. The data indicates that normal cholesterol levels are most common among the study population, with fewer cases of both low and high cholesterol levels.

Table 4: Association Between Albumin Levels and Occurrence of SSI

Table 4 illustrates the association between albumin levels and the occurrence of surgical site infections (SSI) among 50 study participants. Out of 25 individuals with hypo-albuminemia, 11 (44%) had SSI, while 14 (56%) did not. Among those with normal albumin levels, 6 participants (35.3%) experienced SSI, and 11 (64.7%) were free from infection, totaling 17 individuals. In the hyper-albuminemia group, only 1 participant (12.5%) had an SSI, whereas 7 participants (87.5%) did not, out of 8 individuals. This data suggests a higher prevalence of SSI in participants with hypo-albuminemia compared to those with normal or elevated albumin levels.

Table 5: Association Between Total Cholesterol Levels and Occurrence of SSI

Table 5 presents the association between total cholesterol levels and the occurrence of surgical site infections (SSI) among 50 study participants. In the hypo-cholesterolemia group, 12 out of 28 individuals (42%) had SSI, while 16 (58%) did not. Among participants with normal cholesterol levels, only 1 out of 10 individuals (10%) experienced SSI, and 9 (90%) were free from infection. In the hyper-cholesterolemia group, 1 out of 12 participants (8%) had SSI, while the remaining 11 (92%) did not. The data indicates a higher prevalence of SSI in individuals with hypo-cholesterolemia compared to those with normal or elevated cholesterol levels.

Surgical site infections are a common source of morbidity after surgical interventions. [2]Surgical site infections have been demonstrated to elevate mortality, readmission rates, duration of hospitalization, and expenses for affected patients. [3]Nationally, the incidence of surgical site infection for clean cases (Class I/Clean as defined by the CDC) averages between two and three percent, with an estimated 40 to 60 percent of these infections deemed avoidable. A review of the medical literature indicates that the following care components diminish the occurrence of surgical site infections: judicious administration of prophylactic antibiotics; proper hair removal; regulated postoperative serum glucose levels for cardiac surgery patients; and immediate postoperative normothermia for colorectal surgery patients. If properly applied, these components can significantly decrease the occurrence of surgical site infections, leading to the near-total eradication of preventable cases in many instances.[4] The objective of our study is to determine whether preoperative blood cholesterol and albumin levels influence the likelihood of surgical site infections. The current investigation has demonstrated that preoperative hypoalbuminemia and low cholesterol are substantially correlated with the occurrence of postoperative surgical site infections (SSI) and serve as independent risk factors for their development. The analysis of the link between blood albumin, serum cholesterol, and the incidence of superficial and deep surgical site infections (SSIs) indicated that preoperative serum albumin levels below 3.0 mg/dl and cholesterol levels below 150 mg/dl heightened the risk of SSI in this study. The relative risk for hypoalbuminemia and surgical site infection (SSI) in this study was 4.1.This is congruent with research in the literature, such as Neumayer et al. [5], and aligns with Dr. Nowshad M. [6]. The current study data recommends the preoperative assessment of serum albumin and cholesterol upon hospital admission. A further benefit of incorporating albumin and cholesterol measures into hospital protocols is the possible enhancement of management for cardiovascular and renal disorders through early identification.

Both low blood cholesterol and albumin levels are critical factors in post-operative recovery. They contribute to an impaired immune response, delayed healing, and increased susceptibility to infections and other complications. Monitoring and addressing these factors pre-operatively or early in the post-operative period can help reduce the risk of such preventable complications, ensuring better outcomes for patients. Proper nutrition, hydration, and medical interventions to manage cholesterol and albumin levels are essential in promoting optimal recovery and minimizing risks associated with surgery.

1. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF, et Pre- operative serum albumin level as a predictor of operative mortality. Arch Surg. 1999;134(1):36–42.
2. Kirby JP, Mazuski JE. Surg Clin North Am. April 2009;89(2):365-389.
3. Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, et The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization and extra costs. Infect Control Hosp Epidemiology. 1999;20:725.
4. How-to Guide: Prevent Surgical Site Infections. Cambridge, MA: Institute for Healthcare Improvement; 2012; 1-28.
5. Neumayer L, Hosokawa P, Itani K, El-Tamer M, Henderson WG, Khuri SF.Multivariable Predictors of Postoperative Surgical Site Infection after General and Vascular Surgery: Results from the Patient Safety in Surgery Study. Journal of the American College of Surgeons 2007;204(6): 1178-87.
6. Dr Nowshad.M, Dr C.V.Rajendran, Dr Jameela Beevi. Surgical Site Infection – Relevance of Preoperative Assessment of Albumin and Cholesterol. Journal of medical science and medical research 2017; vol 5(7): 24583-24587.