Effect of malnutrition on the postoperative outcomes of patients undergoing pancreatectomy for pancreatic cancer: Propensity score–matched analysis of 2011–2017 US hospitals

Lee, David Uihwan; Hastie, David Jeffrey; Fan, Gregory H.; Addonizio, Elyse Ann; Lee, Ki Jung; Han, John; Karagozian, Raffi

doi:10.1002/ncp.10816

Cited by 10 publications

(7 citation statements)

References 39 publications

(54 reference statements)

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“…SSIs following several types of surgeries 32,[36][37][38][39][40][41] have been reported in patients with pre-operative hypoalbuminemia. In patients undergoing surgeries for pancreatic cancer in specific, evidence points out to the increased morbidity from all causes due to overall malnutrition and hypoalbuminemia 42,43 . A meta-analysis examining the risk factors for SSIs after pancreatic surgery did not show a significant role of albumin in SSI 44 .…”

Section: Discussionmentioning

confidence: 99%

The role of preoperative albumin and white blood cell count in surgical site infections following whipple surgery

Tfaily

Ghanem

Farran

et al. 2022

Sci Rep

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Whipple surgery is associated with a high risk of surgical sites infections (SSIs). Nutritional deficiency has been associated with an increased risk of wound infections. This study aims at exploring the role of preoperative albumin levels in predicting the risk of SSIs following Whipple surgery. A total of 23,808 individuals were identified from the ACS-NSQIP database from years 2011 to 2017. The primary exposure was pre-operative albumin while the secondary exposure was white blood cell (WBC) count. The primary outcome was divided into superficial and deep surgical site infections (S/D SSI) and organ-space SSI. All statistical analyses were conducted using IBM Statistical Package for Social Sciences version 26. Levels of pre-operative serum albumin less than 3.73 g/L, dirty and contaminated wounds and longer operative time were associated with increased odds for developing S/D SSIs (OR = 1.14, OR = 1.17, OR = 1.06, respectively, p-value < 0.05). Pre-operative WBC level (/L) was associated with a risk of developing an organ-space SSI but not S/D SSI (OR = 1.02, p-value 0.003). This study demonstrates the predictive role of pre-operative albumin in developing S/D SSIs and highlights the need to develop therapeutic strategies to optimize the pre-operative nutritional health status of patients undergoing Whipple surgery.

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Section: Discussionmentioning

confidence: 99%

The role of preoperative albumin and white blood cell count in surgical site infections following whipple surgery

Tfaily

Ghanem

Farran

et al. 2022

Sci Rep

View full text Add to dashboard Cite

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“…Earlier studies have described the effect of malnutrition on health outcomes, including postoperative infections following cancer surgery. In patients undergoing pancreatic resection, malnutrition was associated with increased postoperative complications, including infections (odds ratio (OR): 2.63; 95% confidence interval (CI), 1.96; 3.52; p < 0.001) [ 30 ]. Similarly, the risk of surgical complications was significantly higher in malnourished patients with H&N cancer (OR: 8.5; 63% with vs. 17% without; p < 0.001) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Relation of Malnutrition and Nosocomical Infections in Cancer Patients in Hospital: An Observational Study

Muresan

Abad

Artero

et al. 2022

Journal of Nutrition and Metabolism

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Aim. To investigate the relation between malnutrition and nosocomial infections (NI) in hospitalized cancer patients. Methods. This observational, cross-sectional, noninterventional, descriptive study was conducted in a 500-bed university hospital in Valencia (Spain). Adult cancer patients admitted to the oncology ward were consecutively enrolled regardless of their nutritional status between November 2019 and March 2020. Patients were nutritionally assessed 24 to 48 hours after admission. Body weight, height and BMI, body composition through measurement of bioelectrical impedance analysis (BIA), and muscle strength and functionality using hand grip strength (HGS) were prospectively collected. The diagnosis of malnutrition and sarcopenia was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, respectively. Patients were followed up during their hospital stay or outpatient oncology visits to identify possible NI. Results. A total of 107 patients were included in this study (mean age 66 years; 66.4% were men). The most frequent reason for admission was cancer treatment (19.6%), followed by infections (18.7%) and digestive tract symptoms (18.7%). Overall, 77.5% (83/107) of the patients were malnourished at admission according to the GLIM criteria, while 52.3% (56/107) were sarcopenic. Nosocomial infections (NI) were significantly more frequent in malnourished (52.1%; 25/48) and severely malnourished (42.1%; 8/19) patients, compared with well-nourished patients without malnutrition (25%; 10/40; p = 0.035 ). The mean length of hospital stay was 13.9 days, significantly longer in patients with an NI compared to those without infections (18.6 vs. 10.8 days, p < 0.024 ). Conclusion. This study evidenced the need to implement a routine protocol for the nutritional assessment and support of cancer patients at risk of malnutrition and sarcopenia to reduce the risk of NI during their hospital stay.

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“…Chirurgie (siehe auch [34]) Da die krankheitsspezifische Mangelernährung häufig nicht erkannt wird und deswegen unbehandelt bleibt, werden metabolische Faktoren häufig auch nicht bei der kritischen Analyse der postoperativen Morbidität und des Outcomes berücksichtigt. Sehr viele retrospektive [35][36][37][38][39][40][41][42][43] und prospektive [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] große Studien haben den Zusammenhang zwischen einer Einschränkung des Ernährungsstatus und der postoperativen Komplikationsrate und der Letalität herausgearbeitet. Das Vorliegen einer krankheitsspezifischen Mangelernährung ist häufig Ausdruck der Grunderkrankung, wie z.…”

Section: Krankheitsspezifische Mangelernährung In Derunclassified

S3-Leitlinie Klinische Ernährung in der Chirurgie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) e. V.

Weimann,

Breitenstein,

Gabor

et al. 2023

Aktuelle Ernährungsmedizin

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ZusammenfassungDie Vermeidung einer ausgeprägten Katabolie nach chirurgischen Eingriffen mit frühem postoperativen Kostaufbau und Mobilisierung zur raschen Rekonvaleszenz ist heute der Standard des perioperativen Management im so genannten Enhanced Recovery After Surgery (ERAS) Konzept. So ist die frühe orale Nahrungszufuhr auch die bevorzugte Form der postoperativen Ernährung. Gemessen am Kalorienbedarf ist jedoch gerade nach Eingriffen am oberen Gastrointestinaltrakt für längere Zeit von einer verminderten Nahrungsaufnahme auszugehen. Dies birgt grundsätzlich das Risiko eines fortschreitenden Gewichtsverlusts und einer Unterernährung der Patienten während des postoperativen Verlaufs. Mangel- und Unterernährung stellen signifikante Risikofaktoren für postoperative Komplikationen dar. So ist die frühe enterale Ernährung besonders für chirurgische Patienten mit einem bereits bestehenden Ernährungsrisiko wichtig. Der Fokus dieser Leitlinie liegt besonders auf den ernährungstherapeutischen Aspekten des ERAS Konzeptes (Plan A). Dies betrifft präoperativ Strategien zur Konditionierung („Prähabilitation“). Postoperativ können trotz bestmöglicher Versorgung schwere Komplikationen mit der Notwendigkeit zur Reoperation und Intensivtherapie eintreten, die eine besondere, auch medizinische (künstliche) Ernährungstherapie erforderlich machen (Plan B)Aus der Stoffwechsel- und Ernährungsperspektive sind folgende Aspekte in der perioperativen Versorgung zentral:Integration der Ernährung in das gesamte perioperative Management des PatientenVermeidung von längeren perioperativen Nüchternheitsperioden▪ Möglichst frühe Wiederaufnahme der oralen Ernährung nach chirurgischen Eingriffen▪ früher Start einer Ernährungstherapie bei Patienten mit metabolischem Risiko▪ metabolische Kontrolle z. B. des Blutzuckers▪ Reduzierung von Faktoren, die Stress und Katabolie induzieren oder die gastrointestinale Funktion beeinträchtigen▪ Zurückhaltende Gabe von Medikamenten mit ungünstigem Einfluss auf die Darmperistaltik▪ frühe Mobilisation zur Stimulierung der Proteinsynthese und der MuskelfunktionDiese Leitlinie präsentiert insgesamt Empfehlungen für die tägliche klinische Praxis

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Effect of malnutrition on the postoperative outcomes of patients undergoing pancreatectomy for pancreatic cancer: Propensity score–matched analysis of 2011–2017 US hospitals

Cited by 10 publications

References 39 publications

The role of preoperative albumin and white blood cell count in surgical site infections following whipple surgery

The role of preoperative albumin and white blood cell count in surgical site infections following whipple surgery

Relation of Malnutrition and Nosocomical Infections in Cancer Patients in Hospital: An Observational Study

S3-Leitlinie Klinische Ernährung in der Chirurgie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) e. V.

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