Effect of Preoperative Nutritional Status on Surgical Site Infection in Colorectal Cancer Resection

Tanaka, Toshimichi; Sato, Takeo; Yamashita, Keishi; Hosoda, Kei; Nakamura, Takatoshi; Watanabe, Masahiko

doi:10.1159/000448123

“…Several studies have suggested that preoperative nutritional status is an independent risk factor for anastomotic leakage and wound infection in patients with CRC 44,45 . Our study also showed that GNRI was a significant risk factor for wound infection, but it was not a risk factor for anastomotic leakage.…”

Section: Variablesmentioning

confidence: 99%

The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery

Sasaki

¹

,

Miyoshi

²

,

Fujino

³

et al. 2020

Sci Rep

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Malnutrition has been considered to be associated with the prognosis of cancer. the Geriatric nutritional Risk index (GnRi), based on serum albumin levels, present body weight, and ideal body weight, is a simple screening tool to predict the risk of nutrition-related morbidity and mortality in elderly patients. We aimed to evaluate whether preoperative GnRi was associated with postoperative complications and prognosis in elderly patients with colorectal cancer (cRc). We retrospectively enrolled 313 CRC patients aged ≥65 years after curative surgery and classified them into an all-risk GnRi (≤98) group and a no-risk GNRI (>98) group. Kaplan-Meier analysis showed overall survival was significantly worse in the all-risk GNRI group than in the no-risk GNRI group (P = 0.009). Multivariable analyses showed low GnRi (≤98) was an independent risk factor for postoperative complications (P = 0.048) and overall survival (P = 0.001) in the patients. Among the complications, the incidence of surgical site infection, in particular, was significantly higher in the all-risk GNRI group (P = 0.008). In conclusion, low preoperative GnRi (≤98) was associated with increased postoperative complications and poor prognosis. Preoperative GNRI can be used as an identifier for potential high-risk group of morbidity and mortality in elderly cRc patients. Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer-related mortality worldwide 1,2. According to the World Health Organization GLOBOCAN database, there were an estimated 1,849,518 new CRC cases and 880,792 CRC-related deaths in 2018 3. As life expectancy increases and the population ages, the number of elderly patients undergoing surgery also increases 4,5. For instance, in the United States, 60.7% of all the incident CRC patients in 2018 were 65 years or older, and then 81% of the elderly patients and even 64% of the patients aged ≥85 years underwent surgery from 2011 to 2015 3,6. Elderly patients often have some comorbidities, such as cardiovascular disease and respiratory dysfunction 7,8 , and often become malnourished 9,10. In elderly patients, disease-related malnutrition is associated with increased morbidity and mortality 9-12 and prolonged length of stay in hospital due to decrease in their life activity, performance status, and immune function 11-14. The Geriatric Nutritional Risk Index (GNRI) is an elderly-specific index that has been proposed to assess the nutrition-related risk of morbidity and mortality for elderly patients in hospital 15,16. This index was first reported by Bouillanne et al. They divided patients into four groups-a major-risk group (GNRI: <82), a moderate-risk group (GNRI: 82-<92), a low-risk group (GNRI: 92-98), and a no-risk group (GNRI: >98)-and suggested that the risk of infectious complications or mortality was significantly higher in the major-, moderate-, and low-risk groups than in the no-risk group 17. The GNRI is also used for prognosis of chronic diseases 18-20 , and in recent

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“…Preoperative nutritional status is a risk factor for SSIs in colorectal cancer, and its proper preoperative management may reduce the risk of SSIs. [25]. Thus, the preoperative active supplementation of nutrition to maintain an appropriate level of serum A/G plays a signi cant bene cial role in the decrease of SSIs and other postoperative complications [26].…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of surgical site infection after distal femur fractures treated by open reduction and internal fixation: a prospective single-center study

Zhang

¹

,

Li

²

,

Zhao

³

et al. 2020

Preprint

0

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Background: There remain limited data on the epidemiological characteristics and related predictors of surgical site infection (SSI) after open reduction and internal fixation (ORIF) for distal femur fractures (DFFs). We designed this single-centre prospective study to explore and forecast these clinical problems. Methods：From October 2014 to December 2018, 364 patients with DFFs were treated with ORIF and followed for complete data within one year. Receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to screen the adjusted predictors of SSI. Results: The incidence of SSI was 6.0% (22/364): 2.4% (9/364) for superficial SSIs and 3.6% (13/364) for deep SSIs. Staphylococcus aureus (methicillin-resistant S. aureus in 2 cases) was the most common pathogenic bacteria (36.8%，7/19). In multivariate analysis, parameters independently associated with SSI were: Open fracture (OR: 7.3, p = 0.003), drain use (OR: 4.1, p = 0.037), and incision cleanliness (OR: 3.5, p = 0.002). An albumin/globulin (A/G) level ≥ 1.35 (OR: 0.2, p = 0.042) was an adjusted protective factor for SSI. Conclusions: The SSI after ORIF affected approximately one in 15 patients with DFFs. The open fracture, drain use, high grade of intraoperative incision cleanliness, and preoperative A/G levels lower than 1.35 were significantly related to increasing the risk of post-operative SSI after DFFs. We recommended that more attentions should be paid to these risk factors during hospitalization.Trial registration: NO 2014-015-1, October /15/2014, prospectively registered.We registered our trial prospectively in October 15, 2014 before the first participant was enrolled. This study protocol was conducted according to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the Surgical Site Infection in Orthopaedic Surgery (NO 2014-015-1). Data used in this study were obtained from the patients who underwent orthopaedic surgeries between October 2014 to December 2018.

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“…Preoperative nutritional status is a risk factor for SSIs in colorectal cancer, and its proper preoperative management may reduce the risk of SSIs. [25]. Thus, the preoperative active supplementation of nutrition to maintain an appropriate level of serum A/G plays a signi cant bene cial role in the decrease of SSIs and other postoperative complications [26].…”

Section: Days) After Adjusting For Confounding Variables Open Fractmentioning

confidence: 99%

Incidence and predictors of surgical site infection after distal femur fractures treated by open reduction and internal fixation: a prospective single-center study

Zhang

¹

,

Li

²

,

Zhao

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: There remain limited data on the epidemiological characteristics and related predictors of surgical site infection (SSI) after open reduction and internal fixation (ORIF) for distal femur fractures (DFFs). We designed this single-centre prospective study to explore and forecast these clinical problems. Methods：From October 2014 to December 2018, 364 patients with DFFs were treated with ORIF and followed for complete data within one year. Receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to screen the adjusted predictors of SSI. Results: The incidence of SSI was 6.0% (22/364): 2.4% (9/364) for superficial SSIs and 3.6% (13/364) for deep SSIs. Staphylococcus aureus (methicillin-resistant S. aureus in 2 cases) was the most common pathogenic bacteria (36.8%，7/19). In multivariate analysis, parameters independently associated with SSI were: Open fracture (OR: 7.3, p = 0.003), drain use (OR: 4.1, p = 0.037), and incision cleanliness (OR: 3.5, p = 0.002). An albumin/globulin (A/G) level ≥ 1.35 (OR: 0.2, p = 0.042) was an adjusted protective factor for SSI. Conclusions: The SSI after ORIF affected approximately one in 15 patients with DFFs. The open fracture, drain use, high grade of intraoperative incision cleanliness, and preoperative A/G levels lower than 1.35 were significantly related to increasing the risk of post-operative SSI after DFFs. We recommended that more attentions should be paid to these risk factors during hospitalization.

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Effect of Preoperative Nutritional Status on Surgical Site Infection in Colorectal Cancer Resection

Cited by 21 publications

References 30 publications

The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery

The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery

Incidence and predictors of surgical site infection after distal femur fractures treated by open reduction and internal fixation: a prospective single-center study

Incidence and predictors of surgical site infection after distal femur fractures treated by open reduction and internal fixation: a prospective single-center study

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