Preoperative cutaneous hypersensitivity reaction related to postoperative complications following elective surgery

Delayed cutaneous hypersensitivity testing (DCH) using the following antigens: Mumps, PPD, Candida and streptokinase/streptodornase was effectuated preoperatively in 339 surgical patients. DCH test results were evaluated as normal (N) when two or more antigens showed positive response (greater than 5 mm in diameter), relative anergic (RA) with one positive response and anergic (A) when no response was positive. Normal response was observed in 78%, RA in 13% and A in 9% of the patients. Complications in the 232 patients that were operated upon were seen in 51% of the A or RA patients while only 7.1% of the N patients developed complications. The mortality increased significantly from 2.2% in normal patients to 23.5% in the anergic group. Patients classified as anergic or relative anergic had significantly lower preoperative serum levels of prealbumin (p less than 0.001), retinolbinding protein (p less than 0.05) and albumin p less than 0.01) than the normal patients.