Preoperative Nutrition Support May Reduce the Prevalence of Postoperative Pancreatic Fistula after Open Pancreaticoduodenectomy in Patients with High Nutritional Risk Determined by NRS2002

Xu, Jingyong; Tian, Xiaodong; Song, Jinghai; Chen, Jian; Yang, Yinmo; Wei, Junmin

doi:10.1155/2021/6691966

Cited by 14 publications

(13 citation statements)

References 30 publications

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“…So when referring to preoperative therapy, for patients with advanced age, we must pay attention to both nutrition support and function exercise, to improve long-term nutrition and function problems caused by aging, and increase preoperative reservation, which was defined as “prehabilitation” and needed a relatively longer period ( 36 ). And for cancer patients with nutritional risk or malnutrition, we should commit to increasing intake and improving nutrition status by different support routes even for a short period ( 16 , 37 ). Prealbumin might be a biomarker to monitor the effectiveness of preoperative nutrition support but needs further study.…”

Section: Discussionmentioning

confidence: 99%

“…Scores for the final screening take into account all these three sections range from 0 to 7 and classify patients into one of two nutritional risk stages (or groups): at low nutritional risk group (NRS 2002 score < 3), and (moderate/high) risk of malnutrition group (NRS 2002 score ≥ 3). In pancreatic surgery, an NRS2002 score of more and equal to 5 was considered at high nutritional risk with remarkable clinical meaning ( 16 ).…”

Section: Methodsmentioning

confidence: 99%

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Relationship between preoperative malnutrition, frailty, sarcopenia, body composition, and anthropometry in elderly patients undergoing major pancreatic and biliary surgery

Wang

et al. 2023

Front. Nutr.

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ObjectiveTo analyze the correlation between preoperative nutritional status, frailty, sarcopenia, body composition, and anthropometry in geriatric inpatients undergoing major pancreatic and biliary surgery.MethodsThis is a cross-sectional study of the database from December 2020 to September 2022 in the department of hepatopancreatobiliary surgery, Beijing Hospital. Basal data, anthropometry, and body composition were recorded. NRS 2002, GLIM, FFP 2001, and AWGS 2019 criteria were performed. The incidence, overlap, and correlation of malnutrition, frailty, sarcopenia, and other nutrition-related variables were investigated. Group comparisons were implemented by stratification of age and malignancy. The present study adhered to the STROBE guidelines for cross-sectional study.ResultsA total of 140 consecutive cases were included. The prevalence of nutritional risk, malnutrition, frailty, and sarcopenia was 70.0, 67.1, 20.7, and 36.4%, respectively. The overlaps of malnutrition with sarcopenia, malnutrition with frailty, and sarcopenia with frailty were 36.4, 19.3, and 15.0%. There is a positive correlation between every two of the four diagnostic tools, and all six p-values were below 0.002. Albumin, prealbumin, CC, GS, 6MTW, ASMI, and FFMI showed a significantly negative correlation with the diagnoses of the four tools. Participants with frailty or sarcopenia were significantly more likely to suffer from malnutrition than their control groups with a 5.037 and 3.267 times higher risk, respectively (for frailty, 95% CI: 1.715–14.794, p = 0.003 and for sarcopenia, 95% CI: 2.151–4.963, p<0.001). Summarizing from stratification analysis, most body composition and function variables were worsen in the ≥70 years group than in the younger group, and malignant patients tended to experience more intake reduction and weight loss than the benign group, which affected the nutrition diagnosis.ConclusionElderly inpatients undergoing major pancreatic and biliary surgery possessed high prevalence and overlap rates of malnutrition, frailty, and sarcopenia. Body composition and function deteriorated obviously with aging.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Relationship between preoperative malnutrition, frailty, sarcopenia, body composition, and anthropometry in elderly patients undergoing major pancreatic and biliary surgery

Wang

et al. 2023

Front. Nutr.

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“…Multivariable logistic regression analysis was used to evaluate the relationship between risk factors and anemia and postoperative severe complications, respectively, which was expressed as an odds ratio (OR) with 95% confidence intervals (CI). We determined the risk factors by referring to several published articles and what we had in our database, including age, sex, comorbidities, nutrition-related variables, pathology, and some intraoperative items (7,17). We did the logistic analysis of the risk factors of anemia in the total cohort in order to reduce the error caused by missing cases, and we did the analysis of the risk factors of complications in the paired cohort in order to prevent the influence of bias.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Anemia Is a Predictor of Worse Postoperative Outcomes Following Open Pancreatoduodenectomy: A Propensity Score-Based Analysis

Tian

Yang

et al. 2022

Front. Med.

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BackgroundPreoperative anemia is a common clinical situation proved to be associated with severe outcomes in major surgeries, but not in pancreatic surgery. We aim to study the impact of preoperative anemia on morbidity and mortality in patients undergoing open pancreatoduodenectomy and use propensity score matching (PSM) to balance the basal data and reduce bias.MethodsWe analyzed the data of consecutive patients undergoing open pancreatoduodenectomy with a complete record of preoperative hemoglobin, at two pancreatic centers in China between 2015 and 2019. Anemia is defined as hemoglobin less than 12 g/dl for male and 11 g/dl for female, following Chinese criteria. We compared clinical and economic outcomes before and after PSM and used logistic regression analysis to assess the correlation between variables and anemia.ResultsThe unmatched initial cohort consisted of 517 patients. A total of 148 cases (28.6%) were diagnosed with anemia at admission, and no case received a preoperative blood transfusion or anti-anemia therapy. After PSM, there were 126 cases in each group. The rate of severe postoperative complications was significantly higher in the anemia group than in the normal group (43.7% vs. 27.0%, p = 0.006), among which the differences in prevalence of clinically relevant postoperative pancreatic fistula (CR-POPF) (31.0% vs. 15.9%, p = 0.005) and cardiac and cerebrovascular events (4.0% vs. 0.0%, p = 0.024) were the most significant. The costs involved were more in the anemia group (26958.2 ± 21671.9 vs. 20987.7 ± 10237.9 USD, p = 0.013). Among anemic patients, receiver operating characteristic (ROC) curve analysis shows the cut-off value of hemoglobin, below which, patients are prone to suffer from major complications (104.5 g/l in male and 90.5 g/l in female). Among all patients, multivariate analysis showed that preoperative obstructive jaundice [odds ratio (OR) = 1.813, 95% confidence interval (CI) (1.206–2.725), p = 0.004] and pancreatic ductal adenocarcinoma [OR = 1.861, 95% CI (1.178–2.939), p = 0.008] were predictors of anemia. Among paired patients, preoperative anemia [OR = 2.593, 95% CI (1.481–5.541), p = 0.001] and malignant pathology [OR = 4.266, 95% CI (1.597–11.395), p = 0.004] were predictors of postoperative severe complications.ConclusionPreoperative anemia is a predictor of worse postoperative outcomes following open pancreatoduodenectomy and needs to be identified and treated.

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“…Multivariable logistic regression analysis was used to evaluate the relationship between risk factors and anaemia and postoperative severe complications respectively, which was expressed as an odds ratio (OR) with 95% con dence intervals. We determined the risk factors by referring to several published articles and what we had in our database, including age, sex, comorbidities, nutrition related variables, pathology and some intraoperative items [7,17]. We did the logistic analysis of the risk factors of anaemia in total cohort in order to reduce the error caused by missing cases and we did the analysis of the risk factors of complications in the paired cohort in order to prevent the in uence of bias.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Anemia Is A Predictor of Cacoethic Postoperative Outcomes Following Open Pancreatoduodenectomy – A Propensity Score-Based Analysis

Tian

Yang

et al. 2021

Preprint

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Background: Preoperative anaemia is a common clinical situation that was proved to be associated with severe outcomes in major surgery but not pancreatic surgery alone. We aimed to study the impact of preoperative anaemia on morbidity and mortality in patients undergoing open pancreaticoduodenectomy by using propensity score matching (PSM) to balance the basal data and reduce bias. Methods: Consecutive patients undergoing open pancreaticoduodenectomy with complete record of preoperative haemoglobin at two pancreatic centers in China between 2015 to 2019 were analysed. Haemoglobin less than 12g/dl for male and 11g/dl for female were defined as anaemia in Chinese population. Clinical and economic outcomes were compared before and after propensity score matching (PSM). Logistic regression analysis was used to assess correlation between variables and anaemia. Results: The unmatched initial cohort consist of 517 patients. 148 cases (28.6%) were diagnosed as anaemia at admission, and no case received preoperative blood transfusion or anti-anaemia therapy. After PSM, 126 cases were in each group. The rate of severe postoperative complications was significantly higher in anaemia group than in normal group (43.7% versus 27.0%, P=0.006), among which prevalence of clinically relevant postoperative pancreatic fistula (31.0% versus 15.9%, P=0.005) and cardiac and cerebrovascular events (4.0% versus 0.0%, P=0.024) were most significant. It costed more in the anaemia group (26958.2±21671.9 versus 20987.7±10237.9 USD, P=0.013). Among all patients, multivariate analysis showed that preoperative obstructive jaundice [OR 1.813, 95%CI (1.206-2.725), P=0.004] and pancreatic ductal adenocarcinoma [OR 1.861, 95%CI (1.178-2.939), P=0.008] were predictors of anaemia. Among paired patients, preoperative anaemia [OR 2.593, 95%CI (1.481-5.541), P=0.001] and malignant pathology [OR 4.266, 95%CI (1.597-11.395), P=0.004] were predictors of postoperative severe complications.Conclusions: Preoperative anaemia is a predictor of cacoethic postoperative outcomes following open pancreatoduodenectomy and needs identified and treated.

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Preoperative Nutrition Support May Reduce the Prevalence of Postoperative Pancreatic Fistula after Open Pancreaticoduodenectomy in Patients with High Nutritional Risk Determined by NRS2002

Cited by 14 publications

References 30 publications

Relationship between preoperative malnutrition, frailty, sarcopenia, body composition, and anthropometry in elderly patients undergoing major pancreatic and biliary surgery

Relationship between preoperative malnutrition, frailty, sarcopenia, body composition, and anthropometry in elderly patients undergoing major pancreatic and biliary surgery

Preoperative Anemia Is a Predictor of Worse Postoperative Outcomes Following Open Pancreatoduodenectomy: A Propensity Score-Based Analysis

Preoperative Anemia Is A Predictor of Cacoethic Postoperative Outcomes Following Open Pancreatoduodenectomy – A Propensity Score-Based Analysis

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