Malnutrition as a risk factor of adverse postoperative outcomes in patients undergoing hepatic resection: analysis of US hospitals

Abstract

In patients with liver cancer or space-occupying cysts, they suffer from malnutrition due to compression of gastric and digestive structures, liver and cancer-mediated dysmetabolism, and impaired nutrient absorption. As proportion of these patients require removal of lesions through hepatic resection, it is important to evaluate the effects of malnutrition on post-hepatectomy outcomes. In our study approach, 2011-2017 National Inpatient Sample was used to isolate in-hospital hepatectomy cases, which were stratified using malnutrition (composite of malnutrition, sarcopenia, and weight loss/cachexia). The malnutrition-absent controls were matched to cases using nearest neighbor propensity score match method and compared to following endpoints: mortality, length of stay, hospitalization costs, and postoperative complications. There were 2531 patients in total who underwent hepatectomy with matched number of controls from the database; following the match, malnutrition cohort (compared to controls) were more likely to experience in-hospital death (6.60% vs 5.25% p<0.049, OR 1.27 95%CI 1.01-1.61), and were more likely to have higher length of stay (18.10d vs 9.32d p<0.001) and hospitalization costs ($278,780 vs $150,812 p<0.001). In terms of postoperative complications, malnutrition cohort was more likely to experience bleeding (6.52% vs 3.87% p<0.001 OR 1.73 95%CI1.34-2.24), infection (6.64% vs 2.49% p<0.001, OR 2.79 95%CI 2.07-3.74), wound complications (4.5% vs 1.38% p<0.001, OR 3.36 95%CI 2.29-4.93), and respiratory failure (9.40% vs 4.11% p<0.001 OR 2.42 95%CI 1.91-3.07). In multivariate, malnutrition was associated with higher mortality (p<0.028, aOR 1.3 95%CI 1.03-1.65). Thus, we conclude that malnutrition is an independent risk factor of postoperative mortality in patients undergoing hepatectomy.

Does Preoperative Weight Loss Affect Outcomes After Major Liver Resection? Analysis of a National Database

“…Impaired nutrition affects many immune system domains, including the complement system, opsonization, and leukocyte function, leading to increased postoperative nosocomial infections. 1 Previous studies have identified obesity as associated with higher postoperative complications; however, BMI alone cannot identify malnutrition or nutritional risk. [12][13][14] Our results specifically reveal that among those who lose significant weight before surgery, those at the highest risk are underweight, average weight, or morbidly obese.…”

“…Impaired nutrition affects many immune system domains, including the complement system, opsonization, and leukocyte function, leading to increased postoperative nosocomial infections. 1…”

“…Cancer is a well-established cause of weight loss. 1 Weight loss among cancer patients may be driven by many potential factors, including disease-mediated metabolic disorders, anorexia, inflammatory responses, insulin resistance, chemotherapy, depression, and mechanical bowel obstruction. 2 In particular, patients with primary liver malignancies and associated liver disease frequently suffer from protein-energy malnutrition that stems from disrupted cycles of gluconeogenesis, which coincides with the liver-induced rapid turnover of muscular volume and sarcopenic changes as reduced oral intake and cachexia.…”

Orocutaneous Fistula Formation in Free Flap Reconstruction for Oral Squamous Cell Carcinoma

“…Among 2,531 patients undergoing hepatectomy, Lee et al. ( 21 ) reportedly had a higher occurrence of bleeding, infection, wound complication, and respiratory failure in the malnutrition cohort. A similar finding was also confirmed in other solid malignancies ( 22 ), but there are only a few reports regarding head and neck cancers.…”

Combined Resection Approaches: Decision Making for Synchronous Resection, Timing of Staged Intervention to Optimize Outcome

“…[15][16][17][18][19] Malnutrition also increases postoperative mortality in liver surgery. 20 Similar to poor nutritional status, frailty affects outcomes negatively in short and long term after colorectal cancer surgery and liver resection. Assessment of frailty is complex and includes baseline functional status, cognitive function, physical health, comorbidities, social status, and nutritional status.…”