B. P. Nguyen2, F. Perez-Rodriguez2, D. Ruediger2, P. Wischmeyer1, S. Agarwal1, K. Haines1 1Duke University Medical Center, Division Of Trauma, Critical Care, And Acute Care Surgery, Durham, NC, USA 2Kaweah Health Medical Center, Department Of Surgery, Visalia, CA, USA
Introduction:
Over 85% of liver cancer patients are malnourished. There is evidence that patients with hepatocellular carcinoma are at increased risk for malnutrition. Generally, malnutrition can affect patients undergoing hepatic resection leading to higher risk for mortality, length of stay (LOS), hospital costs, and postoperative complications. Worse outcomes have also been associated with liver transplants including requiring more blood products during surgery and having prolonged length of stay. This study aims to analyze the effect of malnutrition on outcomes in liver cancer patients undergoing hepatic resection or liver transplantation with a modified Global Leadership Initiative on Malnutrition (mGLIM) criteria.
Methods:
GLIM introduced a set of phenotypical and etiologic criteria to identify patients as malnourished. We used a modified GLIM, designed to be used with the NSQIP database. The mGLIM is defined as (1) BMI ≤ 20 for age ≤ 70 years and BMI ≤ 22 for age ≥ 71 years, (2) weight loss > 10% within the past 6 months, and (3) admission albumin ≤ 3.5. Patients who meet all three criteria are marked as malnutritioned. Liver cancer patients who underwent liver resection or transplantation on an elective basis were included. Multivariate linear and logistic regression models were used to assess the effect of mGLIM criteria on mortality, LOS, and complications. Covariates were age, sex, race, ethnicity, and comorbidities.
Results:
We included 11,927 patients who underwent elective liver resection or liver transplantation from 2011-2020. Demographically, 36.3% (n = 4,324) were female, 9.2% (n = 1,100) were African American, and 59.8% (n = 7,132) were Caucasian. In total, 0.48% (n = 57) of patients were labeled as malnourished by mGLIM criteria. After analysis with multivariate linear and logistic regression models, patients who are malnourished had longer LOS (p < 0.001, CI 4.51 | 8.09) and higher postoperative complications (p < 0.001, CI 2.29 | 7.24)
Conclusion:
Liver cancer patients who are malnourished, identified by mGLIM criteria, have longer LOS and higher rates of postoperative complications after liver resection or transplantation. These findings support that the mGLIM criteria can be used to improve outcomes for liver cancer patients for whom surgery is indicated. This tool can be used to evaluate the progress of prehabilitation and readiness for surgery.