Significance of the Glasgow prognostic score for short‐term surgical outcomes: A nationwide survey using the Japanese National Clinical Database

Abstract

Aim Preoperative inflammation‐based Glasgow prognostic score (GPS) is a useful tool for predicting long‐term prognosis in cancer patients. However, its association with postoperative short‐term outcomes remains unknown. The aim of this study is to investigate the association between GPS and postoperative morbidity and mortality among patients undergoing surgery for various gastrointestinal malignancies. Methods Using the Japanese National Clinical Database, we analyzed the records of 312 357 patients with gastrointestinal malignancy who underwent six typical elective surgeries, including esophagectomy, distal gastrectomy, total gastrectomy, right hemicolectomy, low anterior resection, and pancreaticoduodenectomy, between January 2015 and December 2018. We assigned GPS of 0, 1, or 2 to patients with no, one, or both decreased albumin and elevated C‐reactive protein levels, respectively. We investigated the relationship of GPS with operative morbidity and mortality for each procedure with adjustments for patients' demographics, preoperative status, comorbidities, and cancer stages. Results Crude operative morbidity was significantly higher for GPS 1 and 2 than GPS 0 patients in all procedures except pancreaticoduodenectomy. The postoperative length of hospital stay was significantly longer for GPS 1 and 2 patients in all procedures (P < .001). Operative mortality was also higher for GPS 1 and 2 patients in all procedures. The associations remained significant after adjustments for potential confounders of age, sex, physical status, tumor classification, use of preoperative therapy, and comorbidities. Conclusion This nationwide study provides solid evidence on the strong association between GPS and postoperative outcomes.

Annual report on National Clinical Database 2020 for gastroenterological surgery in Japan

“… 41 The Glasgow prognostic score was shown to be strongly correlated with postoperative outcomes. 42 Moreover, the mortalities after right hemicolectomy or pancreatoduodenectomy were not affected by day of the week. 43 , 44 In addition, in emergency surgery for acute diffuse peritonitis, antithrombotic drug usage was associated with a slight increase of intraoperative blood loss, which was thought to have little effect on clinical practice.…”

“…With respect to the other issues of postoperative mortality and morbidity rates in the NCD, the impact of reconstruction route on postoperative morbidity after esophagectomy was reported 41 . The Glasgow prognostic score was shown to be strongly correlated with postoperative outcomes 42 . Moreover, the mortalities after right hemicolectomy or pancreatoduodenectomy were not affected by day of the week 43,44 .…”

Salvage transoral videolaryngoscopic surgery for post‐irradiation recurrence of hypopharyngeal carcinoma

“…This study also analyzed systemic factors reportedly associated with postoperative complications, such as the BMI, 31 platelet/lymphocyte ratio, 32 neutrophil/lymphocyte ratio, 33 lymphocyte/monocyte ratio, 34 CRP/albumin ratio, 35 prognostic nutrition index, 36 prognostic index, 37 and GPS 38 . None were associated with postoperative complications, but both patients with a GPS of 1 had complications.…”

“…None were associated with postoperative complications, but both patients with a GPS of 1 had complications. Hiramatsu et al 38 found that patients with GPS 1 and 2 were significantly more likely to have postoperative complications than patients with GPS 0 in various surgeries. Although there were no significant differences in this study, these inflammatory and nutritional factors should be considered preoperatively, and if the risk of complications is high, the treatment should be more carefully considered to avoid postoperative complications.…”

Using preoperative C‐reactive protein levels to predict anastomotic leaks and other complications after elective colorectal surgery: A systematic review and meta‐analysis

“…Preoperative CRP values have been included in a number of observational studies aimed at predicting postoperative risk of morbidity with preoperative laboratory examinations [47,50], evaluating the risk of postoperative infective morbidity across a number of surgical specialities. A preoperative risk score has been developed and validated that relies on preoperative measures of serum CRP and albumin, called the Modified Glasgow Prognostic Score (mGPS) [79]. In this score, patients with preoperative CRP values >10 mg/L are deemed at increased risk of postoperative infective morbidity.…”