V. Lobova1, B.P. Nguyen1, A. Petrak1, C. Vatsaas2, R. Knackstedt4, P. Wischmeyer3, S. Agarwal2, K. Haines2 1Kaweah Health Medical Center, Department Of Surgery, Visalia, CA, USA 2Duke University Medical Center, Division Of Trauma, Critical Care, And Acute Care Surgery, Durham, NC, USA 3Duke University, Department Of Anesthesiology, Durham, NC, USA 4Duke University Medical Center, Department Of Plastic, Maxillofacial, And Oral Surgery, Durham, NC, USA
Introduction:
Malnutrition affects almost 20% of gastric cancer patients. Malnourished gastric cancer patients undergoing gastrectomy have increased mortality and surgical site infections. This study studies malnutrition on outcomes in gastric cancer patients undergoing elective partial or total gastrectomy using the modified Global Leadership Initiative on Malnutrition (mGLIM) criteria.
Methods:
The mGLIM is defined as (1) BMI ≤ 20 for age ≤ 70 years or BMI ≤ 22 for age ≥ 71 years, (2) weight loss > 10% within the past 6 months, (3) admission albumin ≤ 3.5, and (4) gastric cancer as a marker of chronic inflammation. Patients who meet all four criteria are marked as malnourished. Gastric cancer patients who underwent elective partial or total gastrectomy were included. Controlling for age, sex, race, ethnicity, and comorbidities, multivariate linear and logistic regression models were used to measure the effect of mGLIM criteria on mortality, length of stay (LOS), and complications.
Results:
There were 7,633 gastric cancer patients who underwent elective gastrectomy from 2011-2020. Demographically, 42.3% (n = 3,225) were female, 14.6% (n = 1,114) were African American, and 52.0% (n = 3,972) were Caucasian. 1.2% (n = 92) of patients were malnourished as defined by mGLIM criteria. After controlling for covariates, multivariate linear and logistic regression analysis reveal that these patients have a higher mortality (p < 0.001, CI 2.07 | 11.41), longer length of stay (p < 0.001, CI 3.99 | 7.09) and higher postoperative complications (p < 0.001, CI 2.03 | 4.99).
Conclusion:
Using mGLIM, gastric cancer patients identified as malnourished experienced higher mortality, longer LOS, and increased postoperative complications after elective partial or total gastrectomy. Modified GLIM can be used for preoperative risk stratification and guide prehabilitation for gastric cancer patients.