Protein-calorie malnutrition, or both, affects the morbidity and
mortality of patients undergoing operations. Laboratory assessments of
nutritional status consisting of evaluations of serum albumin levels and
total lymphocyte counts are valid tests of a patient's nutritional status.
In this study we examined the influence of preoperative nutritional status
on morbidity in twenty-three diabetic patients who underwent a Syme
amputation. All of the patients met Wagner's criteria for a Syme-level
amputation, but in only 43 per cent (ten patients) did the amputation heal
at this level, which was chosen by Wagner's criteria alone. Of the seven
patients who, in addition to meeting Wagner's criteria, had a serum albumin
level of at least 3.5 grams per deciliter and a total lymphocyte count of
at least 1500 cubic millimeters, in six (86 per cent) the amputation healed
at the Syme level. In contrast, the Syme-level amputation healed in only
two of the eleven patients who met the criteria of Wagner but who had a
serum albumin level of less than 3.5 grams per deciliter and a total
lymphocyte count of less than 1500 cubic millimeters.