Perioperative Serum Albumin and White Blood Cell Count for Early Postoperative Risk Stratification of Superficial Surgical Site Infection After Colorectal Cancer Surgery.

Background

Surgical site infection (SSI) is a common complication after colorectal cancer (CRC) surgery. We evaluated routinely available perioperative biomarkers for early prediction of superficial SSI after curative CRC surgery.

Methods

This retrospective study included 488 patients undergoing elective curative CRC resection. Preoperative and postoperative day (POD) 1 laboratory parameters were evaluated using receiver operating characteristic curve analysis and multivariable logistic regression.

Results

Superficial SSI developed in 66 patients (13.5%). In the perioperative multivariable association model, preoperative serum albumin ≤ 3.70 g/dL (odds ratio [OR], 1.918; 95% confidence interval [CI], 1.066-3.449; p = 0.030) and WBC count ≥ 6.30 × 103/µL (OR, 1.970; 95% CI, 1.123-3.458; p = 0.018) were independently associated with superficial SSI. On POD1, serum albumin ≤ 2.80 g/dL (OR, 3.447; 95% CI, 1.993-5.963; p < 0.001) and WBC count ≥ 10.50 × 103/µL (OR, 2.822; 95% CI, 1.600-4.976; p < 0.001) remained independently associated with SSI. Although lower POD1 lymphocyte-to-monocyte ratio was associated with SSI in univariable analysis, it was not significant after adjustment. A combined model incorporating dichotomized preoperative and POD1 albumin and WBC counts showed modest discrimination (AUC, 0.731; 95% CI, 0.663-0.800), with 47.0% sensitivity and 89.3% specificity.

Conclusions

Perioperative albumin and WBC counts were independently associated with superficial SSI. POD1 assessment may aid early risk stratification; however, the modest performance indicates that these biomarkers should complement rather than replace clinical surveillance. Prospective external validation is required.