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Title: Adverse impact of malnutrition markers on major abdominopelvic cancer surgery.
Austin Authors: Sathianathen, Niranjan J;Kwaan, Mary;Lawrentschuk, Nathan;Weight, Christopher J;Kim, Simon P;Murphy, Declan G;Moon, Daniel A;Konety, Badrinath R
Affiliation: Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA
Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Issue Date: 2019 2019-04-08
Publication information: ANZ Journal of Surgery 2019; 89(5): 509-514
Abstract: Malnutrition has been associated with adverse postoperative outcomes in a range of procedures but none have evaluated the interaction between clinical indicators of malnutrition. We aimed to comparatively evaluate how combinations of nutritional parameters impact postoperative outcomes amongst patients undergoing major cancer operations. Major abdominopelvic cancer surgery cases (colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, nephrectomy, pancreatectomy, pneumonectomy and prostatectomy) were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2007-2016. Malnutrition was defined by the presence of the following parameters: body mass index <18.5 kg/m2 ; preoperative serum albumin <3.0 g/dL or more than 10% weight loss in the last 6 months. Malnourished cases were matched with cases with satisfactory nutritional status using propensity scores. The primary outcome was the incidence of Clavien III-IV complications. Of the 30 207 cases included, 8.5% had at least one marker of malnutrition. The incidence of Clavien III-IV complications across all cases was 5.8%. In the matched cohort, malnourished cases had a higher rate of complications than those with adequate nutritional status (11.3% versus 9.6%, P = 0.018). A correlation was observed between the number of malnutrition markers possessed and the incidence of Clavien III-V complications. Cases with all three makers had the highest likelihood of experiencing a complication (odds ratio 5.47, 95% confidence interval 1.85-16.17). Poor nutritional status confers an increased risk of major postoperative complications and being discharged to a facility in non-upper gastrointestinal cancer patients. There was a correlation between the number of malnutrition parameters and the risk of complications.
DOI: 10.1111/ans.15129
ORCID: 0000-0002-3710-014X
PubMed URL: 30959573
Type: Journal Article
Subjects: malnutrition
nutritional status
outcome assessment
surgical oncology
Appears in Collections:Journal articles

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