Malnutrition is Associated with Poor Postoperative Outcomes Following Laparoscopic Hysterectomy

Abstract

Background: Malnutrition continues to be pervasive among the general population, with rates as high as 50% of patients undergoing surgical procedures. Data is limited about women undergoing surgery for non-malignant gynecologic indications (generally elective laparoscopic hysterectomies, after failed conservative measures). With the significant increase in benign gynecologic surgery, it is of the upmost importance that surgeons optimize modifiable risk factors for patients undergoing laparoscopic hysterectomy. The purpose of this study is to identify the impact of malnutrition on postoperative outcomes in patients undergoing laparoscopic hysterectomy for benign conditions.Methods: A retrospective cohort study was conducted utilizing data that was collected through the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) Database. All patients that underwent laparoscopic hysterectomy for benign indications were identified. Patients with malnutrition were identified by either low albumin (Յ 3.5 g/dL), low body mass index (Յ 18.5), or 10% weight loss within 6 months. The frequency of postoperative complications was evaluated with univariate and multivariate analyses where appropriate.Results: Following adjustment, multivariate analysis illustrated pre-operative malnutrition to be a risk factor for the following complications: any complication, death, bleeding requiring transfusion, wound, cardiac, pulmonary, renal, thromboembolic, sepsis complications, extended length of stay, and reoperation (p Յ 0.05 for all). Conclusion:Malnourished patients were at significantly higher risk of developing postoperative complications during the acute postoperative period. With elective laparoscopic hysterectomies, pre-operative evaluation and intervention for malnutrition should be considered to improve nutritional status.

Malnutrition and Postoperative Outcomes Following Transcervical Zenker Diverticulectomy

“…Before adjusting for demographics and comorbidities, hypoalbuminemia was also associated with multiple complications, including mortality and life‐threatening complications. Mortality and hypoalbuminemia are significantly associated across multiple specialty procedures 32,35 . However, these studies maintain the association after adjustment, unlike our study.…”

“…Mortality and hypoalbuminemia are significantly associated across multiple specialty procedures. 32,35 However, these studies maintain the association after adjustment, unlike our study. Since hypoalbuminemia correlates with multiple comorbidities, multivariable analyses best determine whether it is an independent predictor of poor outcome.…”

“…Studies that show a significant correlation between hypoalbuminemia and race did not align on which race was predisposed to hypoalbuminemia. 32,33 Thus, like other studies, the most relevant demographic variable to consider for hypoalbuminemia is age due to their positive correlation and elderly predisposition to Zenker diverticulum.…”

Association between red blood cell distribution width and mortality in patients with metastatic brain tumors: A retrospective single-center cohort study

“…First, increased RDW is a sign of a nutritional deficiencies and anemia, such as a deficiency of iron, folic acid, or vitamin B-12 (27). Malnutrition was associated with postoperative poor surgical prognosis in many previous studies (28,29). An increase in preoperative RDW may also be associated with anemia and peripheral vascular disease (30), which may lead to intraoperative bleeding risk and blood transfusions (20, 31).…”

Protein-energy malnutrition and worse outcomes after major cancer surgery: A nationwide analysis

“…Surgery, one of the major cancer treatments, can negatively regulate nutrition status due to the catabolic impact of the surgery itself, inflammation induction, and enhanced metabolic stress response (9). Malnutrition is associated with negative clinical outcomes following certain cancer surgeries such as esophagectomy, gastrectomy, colectomy, hepatectomy, pancreatectomy, lung resection, cystectomy, and hysterectomy (10)(11)(12)(13)(14)(15)(16)). However, nationwide population studies on the impact of PEM on outcomes after major cancer surgery (MCS) are lacking.…”