C. Mosquera1, N. J. Koutlas1, K. Chandra1, N. A. Vohra1, E. E. Zervos1, A. Strickland1, F. L. Timothy1 1East Carolina University Brody School Of Medicine,Division Of Surgical Oncology,Greenville, NC, USA
Introduction: The impact of malnutrition on surgical outcomes is difficult to define as studies often use indirect measures of nutrition such as albumin. In order to better understand the effects of malnutrition in the surgical patient, we reviewed a cohort of patients from a single high-volume surgical oncology unit.
Methods: Patients undergoing abdominal surgical procedures on a single surgical oncology unit from June 2013 to March 2015 were reviewed. A dietitian evaluation based on the most recent American Society of Parenteral and Enteral Nutrition/Academy of Nutrition and Dietetics (ASPEN/AND) criteria was used to diagnose malnutrition.
Results: A total of 490 patients were included. Median age was 64 years, a majority were female (50.6%), white (60.2%), well-nourished (81.0%), underwent elective procedures (77.6%), had a Charlson comorbidity score of 3-5 (40.0%), and a Clavien complication grade of 0-II (81.2%). Surgical interventions included colectomy (18.6%), intestinal resection (18.0%), pancreatectomy (18.0%), hepatic resection (10.6%), gastrectomy (5.9%), and other abdominal procedures (29.0%). A total of 93 (19.0%) patients were diagnosed with moderate/severe malnutrition. On univariate analysis, malnourished patients were more likely to be older (66.8 vs. 62.6 years; p= 0.0066) and undergo emergent/urgent procedures (58.1% vs. 14.1%; p= <0.0001). Malnutrition was also associated with a longer length of stay (LOS) (13.3 vs. 7.4 days; p< 0.0001), higher cost ($45,433 vs. $24,658; p< 0.0001), greater mortality (7.5% vs. 2.3%; p= 0.021), more severe complications (30.1% vs. 16.1% Grades III-V; p= 0.0030), and higher readmission rate (22.6% vs. 16.1%; p= 0.045). Gender (p= 0.10) and race (p= 0.60) were similar. On multivariate analysis malnutrition continued to be associated with LOS (1.73; p= 0.045), and cost (2.56; p= 0.0012) while difference in complications (1.52; p= 0.18), mortality (2.21; p= 0.20), and readmission (1.32; p= 0.39) failed to reach significance.
Conclusion: In order to understand the implications of malnutrition, proper assessment is of paramount importance. In this study, malnutrition was associated with prolonged LOS and increased cost. Nutritional interventions to mitigate risk in this at-risk population are warranted.