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Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP.

Hu WH, Cajas-Monson LC, Eisenstein S, Parry L, Cosman B, Ramamoorthy S - Nutr J (2015)

Bottom Line: Only hypoalbuminemia significantly predicted all postoperative complications, even in further multivariate logistic regression analyses (p < 0.001).Multiple regression analysis showed that the hypoalbuminemia group had the highest coefficient in significant association with length of total hospital stay (B = 3.585, p < 0.001) and overall complication (B = 0.119, p < 0.001).Hypoalbuminemia, with levels below 3.5 g/dl, serves as an excellent assessment tool and preoperative predictor of postoperative outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. gary.hu0805@msa.hinet.net.

ABSTRACT

Background: Nutritional status is an important factor in predicting the risk associated with surgery for cancer patients. This is especially true in colorectal cancer. Many nutritional assessments are used in clinical practice, but those assessments are rarely evaluated for their ability to predict postoperative outcome.

Methods: This is a retrospective, multi-institutional study of the ACS-NSQIP database, investigating preoperative nutrition status and its association with postoperative mortality and morbidity.

Results: The prevalence of malnutrition is higher in colorectal cancer, when compared with other most common cancers. Among 42,483 colorectal cancer patients postoperative mortality was significantly associated with hypoalbuminemia (hazard ratio = 3.064, p < 0.001), body weight loss (hazard ratio = 1.229, p = 0.033) and body mass index of <18.5 kg/m(2) (hazard ratio = 1.797, p < 0.001). Only hypoalbuminemia significantly predicted all postoperative complications, even in further multivariate logistic regression analyses (p < 0.001). Multiple regression analysis showed that the hypoalbuminemia group had the highest coefficient in significant association with length of total hospital stay (B = 3.585, p < 0.001) and overall complication (B = 0.119, p < 0.001).

Conclusions: In colorectal cancer, malnutrition significantly contributes to postoperative mortality, morbidity and length of total hospital stay. Hypoalbuminemia, with levels below 3.5 g/dl, serves as an excellent assessment tool and preoperative predictor of postoperative outcomes.

No MeSH data available.


Related in: MedlinePlus

Adjusted odds ratio plot of the association between significant postoperative outcomes with malnutrition. They were evaluated by serum albumin, body weight loss and body mass index, respectively. *p < 0.05, **p < 0.001, multivariate logistic regression. BML, body weight loss; BMI, body mass index; OR, operating room
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Fig2: Adjusted odds ratio plot of the association between significant postoperative outcomes with malnutrition. They were evaluated by serum albumin, body weight loss and body mass index, respectively. *p < 0.05, **p < 0.001, multivariate logistic regression. BML, body weight loss; BMI, body mass index; OR, operating room

Mentions: Multivariate logistic regression analysis was computed to evaluate the relationships among nutrition assessments, 30-day mortality and 6 morbidities that were all significantly associated with the three methods (Fig. 2). After adjustment, hypoalbuminemia was still associated with all postoperative outcome variables (p < 0.001). There was no association when comparing body weight loss with pneumonia, on ventilator > 48 h, septic shock or return to operating room. BMI of <18.5 kg/m2 was not associated with pneumonia or re-intubation. The adjusted odds ratio of 30-day mortality and any of the 6 morbidities was highest in those patients with hypoalbuminemia.Fig. 2


Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP.

Hu WH, Cajas-Monson LC, Eisenstein S, Parry L, Cosman B, Ramamoorthy S - Nutr J (2015)

Adjusted odds ratio plot of the association between significant postoperative outcomes with malnutrition. They were evaluated by serum albumin, body weight loss and body mass index, respectively. *p < 0.05, **p < 0.001, multivariate logistic regression. BML, body weight loss; BMI, body mass index; OR, operating room
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4561437&req=5

Fig2: Adjusted odds ratio plot of the association between significant postoperative outcomes with malnutrition. They were evaluated by serum albumin, body weight loss and body mass index, respectively. *p < 0.05, **p < 0.001, multivariate logistic regression. BML, body weight loss; BMI, body mass index; OR, operating room
Mentions: Multivariate logistic regression analysis was computed to evaluate the relationships among nutrition assessments, 30-day mortality and 6 morbidities that were all significantly associated with the three methods (Fig. 2). After adjustment, hypoalbuminemia was still associated with all postoperative outcome variables (p < 0.001). There was no association when comparing body weight loss with pneumonia, on ventilator > 48 h, septic shock or return to operating room. BMI of <18.5 kg/m2 was not associated with pneumonia or re-intubation. The adjusted odds ratio of 30-day mortality and any of the 6 morbidities was highest in those patients with hypoalbuminemia.Fig. 2

Bottom Line: Only hypoalbuminemia significantly predicted all postoperative complications, even in further multivariate logistic regression analyses (p < 0.001).Multiple regression analysis showed that the hypoalbuminemia group had the highest coefficient in significant association with length of total hospital stay (B = 3.585, p < 0.001) and overall complication (B = 0.119, p < 0.001).Hypoalbuminemia, with levels below 3.5 g/dl, serves as an excellent assessment tool and preoperative predictor of postoperative outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. gary.hu0805@msa.hinet.net.

ABSTRACT

Background: Nutritional status is an important factor in predicting the risk associated with surgery for cancer patients. This is especially true in colorectal cancer. Many nutritional assessments are used in clinical practice, but those assessments are rarely evaluated for their ability to predict postoperative outcome.

Methods: This is a retrospective, multi-institutional study of the ACS-NSQIP database, investigating preoperative nutrition status and its association with postoperative mortality and morbidity.

Results: The prevalence of malnutrition is higher in colorectal cancer, when compared with other most common cancers. Among 42,483 colorectal cancer patients postoperative mortality was significantly associated with hypoalbuminemia (hazard ratio = 3.064, p < 0.001), body weight loss (hazard ratio = 1.229, p = 0.033) and body mass index of <18.5 kg/m(2) (hazard ratio = 1.797, p < 0.001). Only hypoalbuminemia significantly predicted all postoperative complications, even in further multivariate logistic regression analyses (p < 0.001). Multiple regression analysis showed that the hypoalbuminemia group had the highest coefficient in significant association with length of total hospital stay (B = 3.585, p < 0.001) and overall complication (B = 0.119, p < 0.001).

Conclusions: In colorectal cancer, malnutrition significantly contributes to postoperative mortality, morbidity and length of total hospital stay. Hypoalbuminemia, with levels below 3.5 g/dl, serves as an excellent assessment tool and preoperative predictor of postoperative outcomes.

No MeSH data available.


Related in: MedlinePlus