Delayed hypersensitivity testing for the prediction of postoperative complications

Area of Science:

• Surgical Oncology
• Immunology
• Clinical Medicine

Background:

• Cell-mediated immunity plays a crucial role in the body's response to infection.
• Assessing preoperative immune status could potentially identify patients at higher risk for postoperative complications.

Purpose of the Study:

• To investigate the correlation between preoperative cell-mediated immune status and the incidence of postoperative septic complications in patients undergoing major laparotomy.
• To determine if skin testing with recall antigens can predict surgical outcomes.

Main Methods:

• 166 patients undergoing elective major laparotomy were skin tested preoperatively with four common recall antigens.
• Patients were categorized based on their delayed cutaneous hypersensitivity reactions: normally reactive, relatively anergic, and anergic.
• Postoperative morbidity and mortality rates were compared between immune status groups.

Main Results:

• 19 patients were anergic, 22 relatively anergic, and 125 normally reactive.
• No statistically significant differences in postoperative morbidity or mortality were observed between patients with depressed cell-mediated immunity (anergic or relatively anergic) and normally reactive patients.
• Preoperative immune status, as assessed by skin testing, did not correlate with septic complications.

Conclusions:

• Preoperative assessment of cell-mediated immunity using recall antigen skin testing is not a reliable predictor of postoperative septic complications or overall patient outcomes following major laparotomy.
• Current methods of assessing cell-mediated immunity preoperatively do not aid in identifying surgical patients at increased risk for adverse events.