J. T. Brady2, A. R. Althans2, M. Nishtala2, S. L. Stein2, E. Steinhagen2, H. L. Reynolds2, C. P. Delaney4, S. R. Steele3 2University Hospitals Cleveland Medical Center,Surgery,Cleveland, OH, USA 3Cleveland Clinic,Colorectal Surgery,Cleveland, OH, USA 4Cleveland Clinic,Digestive Disease And Surgery Institute,Cleveland, OH, USA
Introduction: Patient risk assessment can aid in stratification, preoperative intervention, and improvement in patient outcomes. While frailty and sarcopenia correlate with outcomes, these can be cumbersome to measure, and a simple objective bedside assessment of patient risk for postoperative complications would be useful. We hypothesized that umbilical cleanliness may be a surrogate for social or hygiene factors that reflect the risk of postoperative complications and discharge disposition.
Methods: A prospective, observational pilot study of patients > 18 years old undergoing colorectal surgery was performed over a two-year period at a tertiary academic medical center. Patients were excluded if they had an abdominal surgery in the prior 90 days, a protruding umbilicus, or prior umbilical excision. A scoring system to characterize the cleanliness of a patient’s umbilicus during routine sterile preparation of the abdomen consisted of a 0 to 5 point scoring system (see table).
Results: We enrolled 200 patients (mean age 58.1±14.8; 56% female). The mean BMI was 28.6±7.4. Indications for surgery included colon cancer (24%), rectal cancer (18%), diverticulitis (13.5%) and Crohn’s disease (12.5%). Umbilical scores were 0 (23%), 1 (26%), 2 (21%), 3 (24%), 4 (6%), and 5 (0%). Postoperative complications occurred in 116 (58%) patients. Increasing umbilical score correlated weakly with postoperative complications (Spearman’s rho=0.15, p=0.04) and increasing modified frailty index (Spearman’s rho=0.14, p=0.05). There was also a correlation with length of stay (Spearman’s rho=0.2, p=0.006), umbilical depth (Spearman’s rho=0.23, p=0.001) and ASA score (Spearman’s rho=0.25, p=0.0005). Umbilical score did not correlate with BMI (Spearman’s rho=0.09, p=0.2), surgical site infection (Spearman’s rho=0.05, p=0.5) or 30-day readmission (Spearman’s rho=0.2, p=0.3). There was no correlation between umbilical score and discharge disposition on univariate analysis (p>0.1).
Conclusion: Although sterile preparation of the abdomen is an important component of proper surgical technique, umbilical cleanliness does not correlate with patient outcomes.
