Risk factors, complications and survival after upper abdominal surgery: a prospective cohort study

Abstract

BackgroundPreoperative weight loss and abnormal serum-albumin have traditionally been associated with reduced survival. More recently, a correlation between postoperative complications and reduced long-term survival has been reported and the significance of the relative proportion of skeletal muscle, visceral and subcutaneous adipose tissue has been examined with conflicting results. We investigated how preoperative body composition and major non-fatal complications related to overall survival and compared this to established predictors in a large cohort undergoing upper abdominal surgery.MethodsFrom 2001 to 2006, 447 patients were included in a Norwegian multicenter randomized controlled trial in major upper abdominal surgery. Patients were now, six years later, analyzed as a single prospective cohort and overall survival was retrieved from the National Population Registry. Body composition indices were calculated from CT images taken within three months preoperatively.ResultsPreoperative serum-albumin <35 g/l (HR = 1.52, p = 0 .014) and weight loss >5 % (HR = 1.38, p = 0.023) were independently associated with reduced survival. There was no association between any of the preoperative body composition indices and reduced survival.Major postoperative complications were independently associated with reduced survival but only as long as patients who died within 90 days were included in the analysis.ConclusionsOur study has confirmed the robust significance of the traditional indicators, preoperative serum-albumin and weight loss. The body composition indices did not prove beneficial as global indicators of poor prognosis in upper abdominal surgery. We found no association between non-fatal postoperative complications and long-term survival.

Preoperative serum albumin level as independent predictor of surgical outcome in acute abdomen

“…11 In a similar study it was stated that serum albumin <3.5g/dl was associated with poor prognosis following abdominal surgery. 12 In the present study the morbidity was increased from 07 (5.5%) to 50 (45.5%).…”

Wound Complications Due to Obesity in the Patients Undergoing Abdominal Surgery

“…Both the central and peripheral types of obesity carries increased risk of some diseases including diabetes mellitus, hypertension, arthritis, coronary heart disease and surgical complications. 14 It is shown from the study that the wound complications occur relatively more commonly in patients with obesity. Obesity can affect the surgical outcome directly or indirectly being the cause of the systemic disorders.…”

Prognostic value of muscle depletion assessed by computed tomography for surgical outcomes of cancer patients undergoing total esophagectomy and gastrectomy

“…In this study, the prevalence of muscle depletion in the initial sample of 77 patients was described as 33.8% by MMI and 64.1% by PTA, with poor agreement between the methods. A study by Aahlin et al also assessed the prevalence of sarcopenia classified by two different cutoff points, and found variations in these rates. CT images of 157 patients who underwent surgery of the upper gastrointestinal tract and hepatobiliopancreatic tract were evaluated using the sliceOmatic software and MMI calculation was performed.…”

“…Using the cutoff point that was also used in this study for MMI, they found a prevalence of sarcopenia in 45.9% of the sample. When performing the classification according to the values proposed by Mourtzakis this index was 70.1% …”