Comparison of preoperative Nutritional Risk Index and Body Mass Index for predicting immediate postoperative outcomes following major gastrointestinal surgery: Cohort-study

Abstract

BackgroundMalnutrition is a major risk factor for morbidity and mortality following gastrointestinal (GI) surgery. Nutritional Risk Index (NRI) and Body Mass Index (BMI) are the two well-validated tools that are readily available and do not add financial burden to the patients. The study aimed to analyze NRI and BMI as a preoperative nutritional indicator of postoperative complications following GI surgeries.MethodsIt is an observational study, where preoperative nutritional status and early postoperative complications <30 days (infectious or noninfectious) were studied. The patients admitted between July 2015 to May 2017, who underwent major GI surgeries were included in the study. The correlation between NRI and BMI of these patients were evaluated.ResultsThe rate of wound infection was 4 (30.7%) out of 13 in severe malnutrition subgroup defined by NRI <83.5 which was found to be statistically significant (p = 0.003). However, it was not significant in a subgroup of patients with undernutrition defined by BMI <18.49%. In a subgroup analysis, abnormal NRI was found to be statistically significant (p = 0.004) in patients with malignant disease and malnutrition 64 (47.76%) out of 97 (72.3%). The mean NRI (94.49 ± 9.164) better correlated with advancing age (p < 0.05) and the correlation coefficient of 0.3100 showed a significant negative correlation. With 10 fold increase in age (r2 = 0.096) the likelihood of malnutrition was 9.6% and subsequently increased postoperative complications.ConclusionIn cases of malignancy and advanced age, NRI is a better predictor of immediate postoperative outcome than BMI.

Prognostic significance of preoperative Naples prognostic score on short- and long-term outcomes after pancreatoduodenectomy for ampullary carcinoma

“…Among these factors, immune-nutritional status is widely recognized as a critical host-related factor. As previously reported (11,16,27,28), patients' immunenutritional status was correlated with tumor progression and patient survival in various cancers. Immune-nutritional status is often assessed by evaluating blood-based parameters, such as serum albumin and total cholesterol concentrations and leukocyte counts.…”

Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center

“…Wound infection is a relatively common stoma closurerelated complication. In the present study, we defined wound infection as the redness or tenderness of the surgical wound with the discharge of pus [30]. We found that wound infection after stoma closure was higher but not significant in Group I (12.5%) than in Group II (7.5%) and Group III (9.1%) (p = 0:783).…”

“…These results could be explained by the reduction of the recovery or immunity of patients in the immediate postoperative period, which leads the host susceptible to infectious complications through diverse cytokine activities [9,31]. In addition, preoperative nutritional status is also one of the major risk factors for wound infection in patients undergoing abdominal surgery [30]. In the present study, the BMI and preoperative albumin level in Group I were lower than those in the other two groups which also might explain the higher frequency of wound infection in Group I.…”

“…Overall, the incidence of LARS was 50.0% in Group I, 54.7% in Group II, and 47.7% in Group III. The median LARS scores for Groups I-III were 17 (interquartile range 6-29), 24 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), and 20 , respectively (p = 0:282). No significant differences were noticed regarding incontinence to feces and flatus, increased stool frequency, clustering, and urgency among the three groups (Table 4).…”

Risk Factors for Malnutrition among IBD Patients

“…This implies that current malnutrition risk screening tools, which do not take into account important IBD-related characteristics, cannot fully categorize malnutrition risk in IBD patients. Previous reports have shown limited MUST performances in IBD, including misclassification of up to one third of patients who eventually developed malnutrition as being at low risk of developing malnutrition [25][26][27]. These studies suggest that the MUST might misclassify some IBD patients who eventually develop malnutrition, lowering the odds of referral to prevention therapy by healthcare givers.…”