Background In patients with cirrhosis, there is a clinical concern that the development of protein-calorie malnutrition will affect the immune system and predispose these patients to increased infectious outcomes. Aims In this study, we evaluate the effects of malnutrition on the infectious outcomes of patients admitted with cirrhosis. Materials and methods This study used the 2011–2017 National Inpatient Sample to identify patients with cirrhosis. These patients were stratified using malnutrition (protein-calorie malnutrition, cachexia, and sarcopenia) and matched using age, gender, and race with 1:1 nearest neighbor matching method. The endpoints included mortality and infectious outcomes. Results After matching, there were 96 842 malnutrition-present cohort and equal number of controls. In univariate analysis, the malnutrition cohort had higher hospital mortality [10.40 vs. 5.04% P < 0.01, odds ratio (OR) 2.18, 95% confidence interval (CI) 2.11–2.26]. In multivariate models, malnutrition was associated with increased mortality [P < 0.01, adjusted odds ratio (aOR) 1.32, 95% CI 1.27–1.37] and infectious outcomes, including sepsis (P < 0.01, aOR 1.94, 95% CI 1.89–2.00), pneumonia (P < 0.01, aOR 1.68, 95% CI 1.63–1.73), UTI (P < 0.01, aOR 1.39, 95% CI 1.35–1.43), cellulitis (P < 0.01, aOR 1.09, 95% CI 1.05–1.13), cholangitis (P < 0.01, aOR 1.39, 95% CI 1.26–1.55), and clostridium difficile (P < 0.01, aOR 2.11, 95% CI 1.92–2.31). Conclusion The results of this study indicate that malnutrition is an independent risk factor of hospital mortality and local/systemic infections in patients admitted with cirrhosis.

Background Frailty aggregates a composite of geriatric and elderly features that is classified into a singular syndrome; literature thus far has proven its influence over postoperative outcomes. In this study, we evaluate the effects of frailty following gastrectomy for gastric cancer. Methods 2011-2017 National Inpatient Sample was used to isolate patients with gastric cancer undergoing gastrectomy; from this, the Johns Hopkins ACG frailty criteria were applied to segregate frailty-present and absent populations. The case-controls were matched using propensity-score matching and compared to various endpoints. Results Post match, there were 1171 with and without frailty who were undergoing gastrectomy for gastric cancer. Those with frailty had higher mortality (6.83 vs 3.50% p < 0.001, OR 2.02 95% CI 1.37-2.97), length of stay (16.7 vs 12.0d; p < 0.001), and costs ($191,418 vs $131,367; p < 0.001); frail patients also had higher rates of complications including wound complications (3.42 vs 0.

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In patients with liver cancer or space-occupying cysts, they suffer from malnutrition due to compression of gastric and digestive structures, liver and cancer-mediated dysmetabolism, and impaired nutrient absorption. As proportion of these patients require removal of lesions through hepatic resection, it is important to evaluate the effects of malnutrition on post-hepatectomy outcomes. In our study approach, 2011-2017 National Inpatient Sample was used to isolate in-hospital hepatectomy cases, which were stratified using malnutrition (composite of malnutrition, sarcopenia, and weight loss/cachexia). The malnutrition-absent controls were matched to cases using nearest neighbor propensity score match method and compared to following endpoints: mortality, length of stay, hospitalization costs, and postoperative complications. There were 2531 patients in total who underwent hepatectomy with matched number of controls from the database; following the match, malnutrition cohort (compared to controls) were more likely to experience in-hospital death (6.60% vs 5.25% p<0.049, OR 1.27 95%CI 1.01-1.61), and were more likely to have higher length of stay (18.10d vs 9.32d p<0.001) and hospitalization costs ($278,780 vs $150,812 p<0.001). In terms of postoperative complications, malnutrition cohort was more likely to experience bleeding (6.52% vs 3.87% p<0.001 OR 1.73 95%CI1.34-2.24), infection (6.64% vs 2.49% p<0.001, OR 2.79 95%CI 2.07-3.74), wound complications (4.5% vs 1.38% p<0.001, OR 3.36 95%CI 2.29-4.93), and respiratory failure (9.40% vs 4.11% p<0.001 OR 2.42 95%CI 1.91-3.07). In multivariate, malnutrition was associated with higher mortality (p<0.028, aOR 1.3 95%CI 1.03-1.65). Thus, we conclude that malnutrition is an independent risk factor of postoperative mortality in patients undergoing hepatectomy.

Objectives In this study, we use a national database to evaluate post‐transcatheter (TAVR)/surgical aortic valve replacement (SAVR) outcomes stratified using chronic liver disease (CLD). Background In patients undergoing TAVR and SAVR, the surgical risks should be optimized; this includes evaluating hepatic diseases that may pose an operative risk. Methods 2011–2017 National Inpatient Sample was used to select in‐hospital TAVR and SAVR cases, which were stratified according to CLD (cirrhosis, hepatitis B/C, alcoholic/fatty/nonspecific liver disease). The cases–controls were matched using propensity score matching and compared with various endpoints. Result After matching for demographics and comorbidities, for TAVR, 606 and 1818 were with or without CLD; for SAVR, 1353 and 4059 were with and without CLD. In TAVR, there was no differences in mortality (2.81% vs. 2.75% OR 1.02 95% CI 0.58–1.78) or length of stay (6.29 vs. 6.44d p = 0.29), and CLD‐present patients had marginally increased costs ($228,415 vs. $226,682 p = 0.048). There were no differences in complications. In multivariate, there was no difference in mortality (aOR 1.02 95% CI 0.58–1.79). In SAVR, CLD patients had higher mortality (7.98% vs. 3.23% OR 2.60 95% CI 2.00–3.38), length of stay (13.3 vs. 11.3 days p < 0.001), and costs ($273,487 vs. $238,097 p < 0.001). CLD patients also had increased respiratory failure (9.02% vs. 7.19% OR 1.28 95% CI 1.03–1.59) and bleeding (8.43% vs. 6.33% OR 1.36 95% CI 1.08–1.71). In multivariate, CLD had higher mortality (aOR 2.60 95% CI 2.00–3.38). Conclusion CLD is associated with higher mortality and complications in patients undergoing SAVR; however, no correlation was found in patients undergoing TAVR.

Background: Patients with pancreatic cancer suffer from metabolic dysregulation, which can manifest in clinical malnutrition. Because a portion of these patients require cancer-resective surgery, we evaluate the impact of malnutrition in patients undergoing pancreatic resection using a national database. Methods: The 2011-2017 National Inpatient Sample was used to isolate cases of pancreatic resection (partial/total pancreatectomy and radical pancreaticoduodenectomy), which were stratified using malnutrition. A 1:1 nearest-neighbor propensity-score matching was applied to match the controls to the malnutrition cohort. End points include mortality, length of stay (LOS), hospitalization costs, and postoperative complications.Results: Following the match, there were 2108 with malnutrition and an equal number without; from this, those with malnutrition had higher mortality (4.

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