Background: Patients with refractory ulcerative colitis (UC) need to undergo total colectomy (TC) and ileal pouch anal anastomosis (IPAA). These patients are often malnourished prior to surgery, especially the patients with severe inflammation of entire colon are severely malnourished. And the incidence of early postoperative septic complications such as surgical site infection (SSI) is relatively high compared to other colorectal diseases. As malnutrition has been reported to be the risk factor of postoperative complication in abdominal surgery, the preoperative nutritional status is also thought to have an influence on these complications after TC for UC. However, it has not been fully evaluated yet which nutritional markers are useful in predicting these postoperative septic complications.
Methods: Forty-four patients with UC who underwent TC in our hospital from 2003 to 2006 were included in this study. Eleven patients underwent TC and IPAA with loop ileostomy, three patients underwent TC with permanent end ileostomy and 30 patients underwent subtotal colectomy with end ileostomy. And nutritional markers such as anthropometry and laboratory data were compared between the patients with and without postoperative septic complications retrospectively.
Results: Septic complications occurred in 14 patients. Thirteen patients were affected by SSI, and one patient was affected by MRSA enteritis. In complication group, serum prealbumin level was significantly lower than in non-complication group (21.8 vs 28.6 mg/dl, p<0.05). Retinol binding protein level was also significantly lower in complication group (2.7 vs 3.7 mg/dl, p<0.01). However, there was no significant difference in serum albumin, choline esterase, total cholesterol and total lymphocyte count between two groups. There was also no significant difference in anthropometry such as BMI, triceps skin fold thickness and arm muscle circumference. Although the preoperative daily dosage of prednisolone just before surgery was compared, no difference was observed between two groups. And no relationship was observed between the route of preoperative nutritional support (oral intake or total parenteral nutrition) and septic complications.
Conclusions: It is suggested that preoperative mesurement of rapid turnover protein level such as prealbumin and retinol binding protein is useful in predicting the risk of postoperative septic complications.