A Clinical study on the effect of preoperative nutritional status on postoperative wound healing in elective laparotomy cases

Malnourishment is the scourge of the developing countries like india.Nutrition is important in many physiological processes like wound healing. In patients posted for surgery, their nutritional status plays an important part in the post operative wound healing and prevention of complications like wound gaping and leakage from anastomosis. In this study we try to establish the relation between four nutritional indices and their effect on the postoperative wound healing and there by the duration of hospital stay. AIMS AND OBJECTIVES: a. To study the preoperative nutritional status with 5 parameters like serum albumin, BMI, Hb, Lymphocyte count. b. To study the nutritional factors affecting wound healing. c. To study the post operative complications of Malnourishment. d. To study the various modalities of prevention and treatment of preoperative Malnourishment and its post operative complications. MATERILS AND METHODS: This prospective study was conducted by selection of random 50 cases posted for major elective surgery from Government Rajaji Hospital, Madurai during the period from Apr 2014 to Sep 2014. The data in the study was collected by the use of a pretested proforma to collect relevant information from individual patient, by a meticulous clinical examination, history taking and specific investigation such as plasma albumin, hemoglobulin, lymphocyte count were carried out 50 cases were studied over a period of 6 months and the outcome documented. ELIGIBILITY CRITERIA: Inclusion Criteria: 1. Patients who were posted for elective laparotomy surgeries in Government Rajaji Hospital, Madurai. 2. Patient without co-morbidities like diabetes, jaundice, connective tissues and chronic renal disorders other immunodeficiency states. 3. Both sexes 15 to 70 yrs of age. Exclusion Criteria: 1. Patients with above said co-morbiditeis. 2. Patients with previous similar surgery. 3. Patients on long term steroids. In all these cases, a thorough clinical examination was carried out Investigations which were relevant for a particular case, like plasma albumin, BMI, Lymphocyte count, Hb, needed for diagnosis were carried out. Patients were then taken for surgery after the required pre-operative preparation and postoperative wound healing was monitored in terms of wound dehiscene, burst abdomen, day of initiation of oral feeds, day of ostomy functioning total days of hospital stay etc. CONCLUSION : From our study it can be fairly concluded that the preoperative nutritional status of the patient has a major impact on the post operative wound healing. A poor pre operative status predisposes to many complications like wound gaping and leak. Serum albumin has an indirect association with incidence of post operative complications and their severity. Level 3.5. The association is statistically significant. Anemia has a detrimental effect on wound healing and its severity is directly reflected on the post operative complications. Blood levels < 10 gms % are found to be significantly associated with post operative morbidity. Obesity observed by BMI values are found to have a relation to post operative complications but there association is not satistically significant. Total Lymphocytes level have a strong association with post operative wound healing