Lower geriatric nutritional risk index predicts postoperative pancreatic fistula in patients with distal pancreatectomy

Abstract

Postoperative pancreatic fistula (POPF) is a common complication following pancreatic resection. It leads to increased medical costs, and longer hospital stays. However, the risk factors of POPF are still unclear, and therefore, this urgent clinical issue should be resolved. The geriatric nutritional risk index (GNRI) is tool to assess the nutritional status using body weight, and serum albumin value, particularly in elderly patients. On the other hand, POPF is associated with body mass index (BMI). Thus, the present study aimed to investigate whether GNRI can predict the risk of POPF in patients after distal pancreatectomy (DP). We conducted a retrospective cohort study involving 37 patients who were treated at the Department of Digestive Surgery, Kawaguchi Municipal Medical Center between January 2007 and June 2018. All patients were subjected to nutritional screening using GNRI, and were followed up after DP for postoperative complications including POPF. In addition, risk factors of POPF, and patient's height, BMI, and preoperative laboratory values were analyzed. POPF was observed in 7 of the 37 (19%) patients. Those with a POPF had significantly lower GNRI values than those without POPF (P<0.001). Receiver operating characteristic curve analysis was performed to determine a cutoff value of GNRI, which indicated an increased risk of POPF. This value was determined as 96 (sensitivity: 71.4%, specificity: 86.7%, likelihood ratio: 5.36). Univariate analysis confirmed that a GNRI of <96 was significantly associated with POPF (P= 0.005), and a multivariate logistic regression analysis revealed that a GNRI of <96 was significant independent predictor of POPF (P= 0.005), suggesting its utility for assessing the risk of POPF following DP.

Drainage volume on postoperative day one to predict clinically relevant postoperative pancreatic fistula following distal pancreatectomy

“…Distal pancreatectomy (DP) is the standard procedure for tumors located in the body or tail of the pancreas [ 2 ]. The digestive pancreatic enzymes leak out of the pancreatic ductal system via an abnormal connection into the peri-pancreatic space or the peritoneal cavity, with resulting morbidity such as abdominal pain, ileus, fever, and the possibility of abscess, sepsis, and hemorrhage and consequently prolonged hospitalization [ 11 ].…”

“…Distal pancreatectomy (DP) is the standard procedure for tumors located in the body or tail of the pancreas [2].…”

“…Distal pancreatectomy (DP) was first performed by Billroth in 1884 and was further outlined by Mayo in 1913 [ 1 ]. This operative is the standard procedure for tumors located in the body or tail of the pancreas, such as pancreatic carcinoma, intraductal papillary mucinous neoplasms, neuroendocrine tumors, and invasive carcinomas from other organ carcinomas including stomach and colon [ 2 ]. Postoperative pancreatic fistula (POPF) is one of the most common complications of pancreatic surgery [ 3 ].…”

Geriatric nutritional risk index serves as risk factor of surgical site infection after pancreatoduodenectomy: a validation cohort Ageo study

“…Accordingly, studies have reported that 45-55% of patients with POPFs developed intra-abdominal abscesses (13,14). Recent reports have also revealed an association between nutritional status and POPF among patients who had undergone pancreatic resection (15,16). Identified risk factors for SSIs following PD generally include preoperative bile drainage, BMI, age, neoadjuvant chemotherapy, operative time, estimated blood loss, pancreatic duct diameter, and nutritional status (17)(18)(19).…”

Geriatric Nutritional Risk Index Less Than 92 Is a Predictor for Late Postpancreatectomy Hemorrhage Following Pancreatoduodenectomy: A Retrospective Cohort Study

“…Among them, we focused on GNRI, which includes albumin and BMI, primarily because of availability of the required parameters and lack of invasiveness. Until now, it had been reported that lower GNRI was associated with increased risk of surgical site infections in patients following PD [ 11 ], and POPF in patients with distal pancreatectomy at a different hospital [ 22 ]. In detail, a lower GNRI value was strongly associated with a higher risk of surgical site infections, supporting the use of nutritional assessment prior to an elective surgical procedure.…”