Preoperative nutritional status is independently associated with wound healing in patients undergoing open surgery for ischemic tissue loss
Kiyoshi Tanaka, Shinichi Tanaka, Jin Okazaki, Shinsuke Mii
Abstract
Objectives The aim of this study was to determine the relationship between preoperative nutritional status and wound healing in patients undergoing surgical reconstruction for ischemic tissue loss. Methods The preoperative nutritional status of patients who underwent surgical reconstruction for ischemic tissue loss for the years 2011–2018 was retrospectively estimated using the Controlling Nutritional Status (CONUT) score. Patients were allocated to two groups: Group I, normal nutrition or mild malnutrition (CONUT score ≤4), and Group II, moderate-to-severe malnutrition (CONUT score ≥5). Wound healing was set as the primary endpoint and major amputation and death as the secondary endpoints. The wound healing, limb salvage, and overall survival rates were calculated after two years using the Kaplan–Meier method, and Cox proportional hazards regression analysis was performed to determine which variables were independently associated with these outcomes. Results Forty-eight patients with missing values for the CONUT score were excluded. A total of 174 limbs in 147 patients were studied (Group I: 115 limbs in 100 patients; Group II: 59 limbs in 47 patients). The mean duration of the study was 519 ± 270 days. The Kaplan–Meier curves showed that wound healing in Group I was superior to that in Group II (Group I vs. II: two-year wound healing, 97% vs. 79%; time to 50% wound healing, 83 vs. 150 days, p < 0.001), and multivariate analysis showed that the CONUT score was an independent predictor of wound healing (hazard ratio, 0.63; 95% confidence interval, 0.41–0.98; p = 0.038). Conclusions Patients with better preoperative nutritional status are more likely to experience wound healing earlier than those with excessive malnutrition.