Comparison of four nutritional screening tools in perioperative elderly patients: Taking orthopedic and neurosurgical patients as examples

Abstract

Background and aimsMalnutrition is widely present in elderly surgical patients and is highly correlated with prognosis after surgery. However, studies comparing the effectiveness of comprehensive nutritional screening tools in geriatric surgical patients have not yet been published. The nutritional risk among elderly orthopedic and neurosurgical patients and their associated clinical indicators and outcomes was assessed using four screening tools. The aim of this study was to explore suitable tools for screening the nutritional status and identify their potential to act as prognostic indicators.MethodsThe Nutritional Risk Score 2002 (NRS2002), Mini Nutritional Assessment - Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI) were all performed within two days of admission and before surgery. The relationships between nutritional risk classifications and conventional nutritional markers, complications and length of hospital stay (LOS) were evaluated.ResultsIn this study, a total of 167 orthopedic patients and 103 neurosurgical patients were evaluated. In neurosurgical patients, the rates of malnutrition or patients at risk of malnutrition according to the MNA-SF, GNRI, NRS2002 and PNI were 26.4, 24.6, 8.4, and 12.6%, respectively. According to the NRS2002 and PNI, the rates of old neurosurgical patients who were malnourished or at risk of malnutrition were 14.6 and 3.9%, respectively, which were lower than the results assessed by the MNA-SF (24.3%) and GNRI (15.5%). Multiple regression analysis revealed a significant relationship between the PNI (malnourished vs.well-nourished, OR = 5.39, 95% CI:1.11-26.18, P = 0.037), GNRI (at risk vs.no risk, OR = 3.96, 95% CI: 1.01-15.45, P = 0.048) and the complications in orthopedic patients. Only GNRI was significantly related to LOS > 7 days (at risk vs.no risk, OR = 4.01, 95% CI: 1.64-9.80, P = 0.002). For neurosurgical patients, an association between GNRI and LOS > 8 days was discovered (at risk vs.no risk, OR = 3.35, 95% CI: 1.03-10.86, P = 0.002).ConclusionAmong the four nutritional risk screening tools, the GNRI exhibited better predictive value for short-term outcomes in elderly perioperative orthopedic and neurosurgical patients, thereby suggesting that it might be a more suitable tool for nutritional risk screening. Additional studies are required to determine the applicability of GNRI in other surgical fields.

Shoulder arthroscopy in elderly patients: malnutrition and early postoperative outcomes

“…This finding concurs with pre-existing literature. 7 , 10 , 12 , 15 , 24 Our study discovered a greater likelihood of any complication, sepsis, nonhome discharge, readmission, unplanned reoperation, and increased LOS for both degrees of malnutrition. For complications independently associated with both moderate and severe malnutrition, severe malnutrition was generally found to have stronger associations: any complication (OR 1.84 in moderate malnutrition vs. 11.70 in severe malnutrition), sepsis (OR 3.75 vs. 26.61), nonhome discharge (OR 2.09 vs. 15.75), readmission (OR 1.66 vs. 2.69), unplanned reoperation (OR 4.23 vs. 6.32), and LOS >2 days (OR 2.37 vs. 23.66).…”

The geriatric nutritional risk index as a strong predictor of adverse outcomes following total shoulder arthroplasty

“… 5 GNRI has displayed reliability and validity comparable to established nutritional assessments; notably, poor prognosis following orthopedic surgeries was most effectively predicted by GNRI scores. 16 Furthermore, studies support the use of GNRI in cases where questionnaires such as MNA cannot be performed, even encouraging the use of both assessments to allow for more accurate results. 12…”

Do nutritional assessment tools (PNI, CONUT, GNRI) predict adverse events after spinal surgeries? A systematic review and meta-analysis

“…Despite all three indices being associated with adverse outcomes, the superiority of one index over others has not been established. Gong et al [ 41 ] in a cohort of 167 orthopedic patients and 103 neurosurgical patients have shown that both PNI and GNRI are predictors of adverse events and longer hospital stays, but the GNRI may have a better predictive ability. In a cohort of 113 patients undergoing pancreaticoduodenectomy, Cong et al [ 42 ] have shown that all three indices were predictors of postoperative complications but PNI had the highest diagnostic efficacy.…”