In 58 fracture-surgery patients, higher preoperative total protein and lower early postoperative sodium were associated with wound complications.

Key Highlights

• Postoperative wound complications developed in 18 of 58 patients (31%).
• Higher preoperative total protein and female sex were associated with complications in the preoperative multivariable model.
• Lower serum sodium was associated with complications in the early postoperative model.
• The authors emphasized that these exploratory findings require prospective confirmation and external validation before clinical use.

Higher preoperative serum total protein and lower early postoperative sodium were associated with wound complications after peri-ankle fracture surgery in a retrospective cohort study published in the Journal of Clinical Medicine.¹ Female sex was also associated with complications, but the investigators cautioned that the findings do not establish causal mechanisms or validated clinical predictors.

The single-center study examined whether routine blood tests obtained before and shortly after surgery were associated with postoperative wound outcomes.¹ Researchers used a clinically restricted fracture population to reduce variation in anatomy, surgical management, and factors affecting wound healing.

Investigators reviewed records of adults undergoing surgery between January 1 and November 30, 2022.¹ Eligible patients underwent open reduction and internal fixation through a single open approach. Of 130 patients screened, 58 met the criteria; exclusions included open fractures, revision procedures, active infection, poorly controlled diabetes, and symptomatic peripheral vascular disease.

Laboratory measurements were obtained within 24 hours before surgery and during the first six postoperative hours.¹ Researchers evaluated a composite wound-complication outcome during the primary three-week observation period. Analyses included univariate comparisons, false-discovery-rate adjustment, receiver operating characteristic curves, and separate Firth penalized multivariable logistic regression models for preoperative and early postoperative parameters.

Wound complications occurred in 18 patients (31%).¹ After adjustment for multiple comparisons, preoperative platelet count and total protein remained statistically significant. In the preoperative multivariable model, higher total protein was associated with complications, as was female sex. Total protein had the highest preoperative discriminatory performance, with an area under the curve of 0.886. 

Early postoperative sodium, basophil count, chloride, hemoglobin, and neutrophil-to-lymphocyte ratio remained significant after multiple-comparison adjustment.¹ In the postoperative multivariable model, lower sodium was associated with complications. Sodium showed the highest early postoperative discriminatory performance, with an area under the curve of 0.808.

According to the authors, the associations and data-derived thresholds require confirmation in larger prospective cohorts before their clinical utility can be determined.¹ They specifically urged caution in interpreting the unexpected association between higher total protein and complications.

For wound professionals, this study highlights the continued need to examine the potential impact of nutrition and metabolic status on all wound types, including surgical wounds.

Reference

1. Erdoğan E, Gencer EN, Yeni TB, Türkoğlu F, Doğan Ö. Associations of preoperative and early postoperative biomarkers with wound complications in a clinically restricted surgical population: a retrospective cohort study. J Clin Med. 2026;15(19):7647. doi:10.3390/jcm15197647