Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

Abstract

Background: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults. Methods: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition. Results: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14–7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10–8.63, p = 0.032)). Conclusion: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative period

Association between C-reactive protein-albumin-lymphocyte (CALLY) index and overall survival in patients with colorectal cancer: From the investigation on nutrition status and clinical outcome of common cancers study

“…In addition to inflammation, the roles of nutrition status in the occurrence and development of CRC could not be ignored ( 7 , 8 ). On one hand, CRC cells affect the absorption and utilization of nutrients through inflammation and metabolic processes, making patients with CRC are prone to malnutrition ( 25 , 26 ). On the other hand, due to the gastrointestinal symptoms, which affect the appetite and eating, most of the patients with CRC have varying degrees of malnutrition risk ( 25 ).…”

Moderate-to-Severe Malnutrition Identified by the Controlling Nutritional Status (CONUT) Score Is Significantly Associated with Treatment Failure of Periprosthetic Joint Infection

“…Our study preliminarily illustrated the clinical guidance of the CONUT score as a reliable nutritional screening tool. Similarly, CONUT has been demonstrated to have good prognostic value in cancers and other infections [ 35 , 55 , 56 ]. Although the exact mechanism is uncertain, this association may be explained by the nutritional and immune-related parameters in CONUT [ 57 ].…”

Prevalence of Anxiety and Depression Symptoms and Their Relationship with Nutritional Status and Mortality in Patients with Colorectal Cancer

“…For nutritional assessment, we used GLIM criteria, which were born as a result of a consensus of several international organizations for a definition of malnutrition [ 6 ]. Several studies reported malnutrition rates in CRC patients from 20% to 37%, depending on the tool used to assess nutritional status [ 1 , 19 , 20 ]. Other studies showed that malnutrition can affect up to 60% of these patients [ 21 , 22 ].…”