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Adverse impact of malnutrition markers on major abdominopelvic cancer surgery
Author(s) -
Sathianathen Niranjan J.,
Kwaan Mary,
Lawrentschuk Nathan,
Weight Christopher J.,
Kim Simon P.,
Murphy Declan G.,
Moon Daniel A.,
Konety Badrinath R.
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15129
Subject(s) - medicine , malnutrition , odds ratio , incidence (geometry) , surgery , body mass index , complication , cancer , physics , optics
Background 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. Methods 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/m 2 ; 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. Results 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). Conclusion 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.