Simplified Nutritional Scoring System Predicts Complicated Outcomes of Upper Gastrointestinal Surgery

Postoperative complications after major upper gastrointestinal surgery can be devastating. Malnutrition has been found to be an important risk factor for postoperative complications. However, trying to detect malnourished patients preoperatively can be cumbersome and complex, and is often not done. One simplified way of assessing nutritional status is the automated nutritional scoring (ANS) system. The aim of this study was to show the relationship between the ANS score and the postoperative outcome. The medical records of all patients undergoing major esophogastric and hepatobiliary surgeries at Concord Hospital between 2010 and 2012 were retrospectively analyzed. A total of 83 patients were operated and included Whipple procedure (20.5%); total/subtotal gastrectomy (44.6%); Ivor-Lewis esophagectomy (18%); and distal pancreatectomy (14.5%). The mean ANS score was 1.58. Patients with higher ANS scores (2 or more) were found to have significantly higher rates of wound infection (41% versus 12%, P < 0.002); anastomotic leaks (13.7% versus 1.92%, P = 0.034); unexpected return to the operating room (31% versus 3.9%, P < 0.001); and slower return of bowel function compared to patients with low ANS scores (0 or 1). This study demonstrates the importance of screening for malnourished patients prior to their operation. Given its simplicity and effective predictive value, we recommend use of ANS.