-Original-

Worse Preoperative Status Based on Inflammation and Host Immunity Is a Risk Factor for Surgical Site Infections in Colorectal Cancer Surgery

Masano Sagawa¹, Kazuhiko Yoshimatsu¹, Hajime Yokomizo¹, Yuki Yano¹, Sachiyo Okayama¹, Takebumi Usui¹, Kentaro Yamaguchi¹, Shunichi Shiozawa¹, Takeshi Shimakawa¹, Takao Katsube¹, Hiroyuki Kato² and Yoshihiko Naritaka¹

¹Department of Surgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
²Department of Clinical Laboratory, Tokyo Women's Medical University Medical Center East, Tokyo, Japan

Objective: The modified Glasgow Prognostic Score (mGPS) is an inflammation-based measure of malnutrition that reflects a state of cachexia in cancer patients. We evaluated mGPS as an index to predict surgical site infection (SSI) incidence in patients undergoing colorectal cancer surgery.
Subjects and Methods: We retrospectively analyzed 351 patients who underwent colon cancer resection. Factors correlated with the incidence of SSIs were identified by logistic analysis and stepwise selection.
Results: SSIs were observed in 32 patients, with an incidence of 9.1%. Univariate logistic analysis revealed mGPS (Score 2), laparotomy, resection of other organs, colostomy, excessive blood loss (>423 mL), long duration of surgery (>279 minutes), pulmonary dysfunction, prognostic nutritional index (PNI) ≤40, neutrophil lymphocyte ratio (NLR)(>4), and controlling nutritional status (CONUT) ≥2 to be associated with an increased incidence of SSIs. Multivariate analysis with variables selected by the stepwise procedure also revealed mGPS (Score 2) (Odds ratio (OR)=3.55, 95% Confidence interval (CI) 1.30-9.56; p=0.01), colostomy (OR=6.56, 95%CI 1.60-31.38; p=0.01), excessive blood loss (OR=3.20, 95%CI 1.23-8.42; p=0.02), and NLR (>4)(OR=3.24, 95%CI 1.31-8.17; p=0.01) to be independent risk factors.
Conclusion: mGPS is an independent risk factor for SSIs. Our results suggest that cachexia before surgery in patients with colorectal cancer might predict the incidence of SSIs.

J Nippon Med Sch 2017; 84: 224-230

Keywords
modified Glasgow Prognostic Score (mGPS), surgical site infection (SSI), colorectal cancer surgery

Correspondence to
Kazuhiko Yoshimatsu, MD, PhD, Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan
kyoshsu@dnh.twmu.ac.jp

Received, March 7, 2017
Accepted, August 8, 2017