A SECONDARY ANALYSIS OF SELECTED FACTORS ASSOCIATED WITH POSTOPERATIVE INFECTION IN MALNOURISHED SURGICAL PATIENTS.
Contributors: University of Pennsylvania.
Published: 1995
Number of pages: 121
Subjects: Health Sciences, Nursing.; Health Sciences, Nutrition.; Health Sciences, Medicine and Surgery.
Description: The Department of Veterans Affairs (DVA) clinical trial of perioperative total parenteral nutrition (TPN) in malnourished surgical patients, undertaken to determine if TPN would reduce operative morbidity, found no differences in overall postoperative complication rates but a significantly higher rate of postoperative infection in TPN-treated patients. It remains unclear whether the higher rate of infection was causally related to TPN administration or to other risk factors for infection.

The purpose of this secondary analysis of the DVA clinical trial data was to examine the interrelationships among variables proposed to contribute to postoperative infection in malnourished surgical patients and to identify factors that were different in patients who developed postoperative infection as compared to those who did not.

The relationship of 13 nutrition, operation, and patient-related risk factors to postoperative infection was examined using bivariate correlation. Six variables; carbohydrate intake, non-use of the gastrointestinal tract, preoperative hyperglycemia, preoperative central venous catheter (CVC), duration of the operation, and operative wound classification, were found to have a significant bivariate relationship with infection, and were selected for inclusion in the logistic regression model. Of those variables, only duration of the operation (p = 0.0013), operative wound classification (p = 0.0125), and a preoperative CVC (p = 0.03), entered into the model as independent predictors of infection.

Duration of the operation was the strongest predictor of infection. As the duration of the operation increased, the risk for infection also increased. An operative wound classified as contaminated/dirty was the next strongest predictor of infection. Subjects with a contaminated/dirty wound were 3.1 times more likely to develop an infection, as compared to subjects with clean wounds. The final predictor of infection was the presence of a CVC. Subjects with a CVC were 2.1 times more likely to develop an infection, as compared to those without a CVC. However, the presence of a CVC and the administration of TPN were highly correlated (r = 0.93). The variable CVC may have served as a proxy measure for TPN administration.
Notes: Source: Dissertation Abstracts International, Volume: 56-05, Section: B, page: 2559.

Thesis (PH.D.)--UNIVERSITY OF PENNSYLVANIA, 1995.

School code: 0175.