Emerging Impact of Malnutrition on Surgical Patients: Literature Review and Potential Implications for Cystectomy in Bladder Cancer

Tobert, Conrad M.; Hamilton-Reeves, Jill; Norian, Lyse A.; Hung, Chermaine; Brooks, Nathan; Holzbeierlein, Jeff M.; Downs, Tracy M.; Robertson, Douglas; Grossman, Ruth; Nepple, Kenneth G.

doi:10.1016/j.juro.2017.01.087

Cited by 78 publications

(50 citation statements)

References 50 publications

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“…Of interest, a significant number of patients considered hypermetabolic do not report loss of body weight and are characterized by good performance status (141). The lack of correlation between body weight loss and hypermetabolism is also confirmed by another study performed on bladder cancer patients, showing that the recovery after surgery is faster for metabolic rates than for body weight loss (135).…”

Section: Fig 1 Cancer Cachexia Is a Multifactorial Syndromementioning

confidence: 90%

The Redox Balance: A Target for Interventions Against Muscle Wasting in Cancer Cachexia?

Penna

Ballarò

Costelli

2020

Antioxidants & Redox Signaling

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Significance: The management of cancer patients is frequently complicated by the occurrence of a complex syndrome known as cachexia. It is mainly characterized by muscle wasting, a condition that associates with enhanced protein breakdown and with negative energy balance. While the mechanisms underlying cachexia have been only partially elucidated, understanding the pathogenesis of muscle wasting in cancer hosts is mandatory to design new targeted therapeutic strategies. Indeed, most of cancer patients will experience cachexia during the course of their disease, and about 25% of cancer-related deaths are due to this syndrome, rather than to the tumor itself. Recent Advances: Compelling evidence suggests that an altered redox homeostasis likely contributes to cancerinduced muscle protein depletion, directly or indirectly activating the intracellular degradative pathways. In addition, oxidative stress impinges on both mitochondrial number and function; the other way round, altered mitochondria lead to enhanced redox imbalance, creating a vicious loop that eventually results in negative energy metabolism. Critical Issues: The present review focuses on the possibility that pharmacological and nonpharmacological strategies able to restore a physiologic redox balance could be useful components of treatment schedules aimed at counteracting cancer-induced muscle wasting. Future Directions: Exercise and the use of exercise mimetic drugs represent the most promising approaches capable of reinforcing the muscle antioxidant defenses of cancer patients. The results from ongoing and new clinical trials are needed to validate the preclinical studies and provide effective therapies for cancer cachexia.

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Section: Fig 1 Cancer Cachexia Is a Multifactorial Syndromementioning

confidence: 90%

The Redox Balance: A Target for Interventions Against Muscle Wasting in Cancer Cachexia?

Penna

Ballarò

Costelli

2020

Antioxidants & Redox Signaling

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“…Wound and infectious complications were amongst the costliest during the index stay and are relatively common at 11.2%. RC patients have predisposing factors for infectious complications including smoking history, history of chemotherapy, and poor nutrition prior to surgery, improving nutrition , encouraging smoking cessation , and promoting exercise may be valuable opportunities to promote recovery and decrease complications. In addition, infectious complications may also relate to the overuse of antimicrobial prophylaxis in urological surgery, variability in practice patterns among providers, and suboptimal compliance with clinical guidelines .…”

Section: Discussionmentioning

confidence: 99%

Associations of specific postoperative complications with costs after radical cystectomy

et al. 2017

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ObjectiveTo quantify the financial impact of complications after radical cystectomy (RC) and their associations with respective 90-day costs, as RC is a morbid surgery plagued by complications and the expenditure attributed to specific complications after RC is not well characterised. Patients and MethodsWe used the Premier Hospital Database (Premier Inc., Charlotte, NC, USA) to identify 9 137 RC patients (weighted population of 57 553) from 360 hospitals between 2003 and 2013. Complications were categorised according to Agency for Healthcare Research and Quality Clinical Classifications. Patients with and without complications were compared, and multivariable analysis was performed. ResultsAn index complication increased costs by $9 262 (95% confidence interval [CI] 8 300-10 223) and a readmission complication increased costs by $20 697 (95% CI 18 735-22 660). The four most costly index complications (descending order) were venous thromboembolism (VTE), infection, wound and soft tissue complications, and pulmonary complications (P < 0.001, vs no complication). A complication increased length of stay by 4 days (95% CI 3.6-4.3). One in five patients were readmitted in 90 days and the four costliest readmission complications (descending order) were pulmonary, bleeding, VTE, and gastrointestinal complications (P < 0.001, vs no complication). Readmitted patients had multiple complications upon readmission (median of 3, interquartile range 2-4). On multivariable analysis, more comorbidities, longer surgery (>6 h), transfusions of >3 units, and teaching hospitals were associated with higher costs (P < 0.05), whilst high-volume surgeons and shorter surgeries (<4 h) were associated with lower costs (P < 0.05). ConclusionsComplications after RC increase index and readmission costs for hospitals, and can be categorised based on magnitude. Future initiatives in RC may also consider costs of complications when establishing quality improvement priorities for patients, providers, or policymakers.

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“…Patients undergoing RC are at significant risk for malnutrition due to their age, comorbidities, and disease-related factors [ 22 ]. The interaction between obesity and malnutrition and the relative association of these two potentially modifiable risk factors with perioperative outcomes remains to be defined.…”

Section: Introductionmentioning

confidence: 99%

Early Complications and Mortality following Radical Cystectomy: Associations with Malnutrition and Obesity

Arora

Hanson

Habermann

et al. 2018

BLC

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Background:There are conflicting data regarding the impact of obesity on postoperative outcomes following radical cystectomy (RC) and how obesity and malnutrition interact in patients undergoing RC.Objective:To evaluate associations of body mass index (BMI), significant preoperative weight loss, and hypoalbuminemia with 30-day complications and mortality after RC.Methods:Review of the American College of Surgeons National Surgical Quality Improvement Program database identified 2,055 patients who underwent RC (2006-12). Univariate and multivariable logistic regression models were developed to assess associations between hypoalbuminemia (<3.5 g/dL), >10% preoperative weight loss, obesity as characterized by BMI (class I: 30–34.9, II: 35–39.9, III: ≥40 kg/m2), and 30-day complications and mortality.Results:The median BMI of the study cohort was 27.82 kg/m2 with 22.4% classified as having class I, 7.5% class II, and 4.2% class III obesity, respectively. Hypoalbuminemia and >10% weight loss were present in 16.7% and 3.5%, respectively. Among obese patients, 13.4% had hypoalbuminemia. On multivariable analysis, class I (OR 1.43, p = 0.01), class II (OR 1.92, p < 0.001), and class III (OR 2.32, p < 0.001) obesity and hypoalbuminemia (OR 1.47, p = 0.02) were independently associated with 30-day complications, and class III obesity (OR 2.96, p = 0.02) and hypoalbuminemia (OR 2.33, p = 0.03) were independently associated with 30-day mortality.Conclusion:Increasing class of obesity and hypoalbuminemia were independently associated with increased complications following RC. Hypoalbuminemia and class III obesity were associated with early mortality. This study highlights the fact that malnutrition may coexist in obese patients and underscores the need to identify patients with malnutrition who may be candidates for preoperative nutritional optimization.

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Emerging Impact of Malnutrition on Surgical Patients: Literature Review and Potential Implications for Cystectomy in Bladder Cancer

Cited by 78 publications

References 50 publications

The Redox Balance: A Target for Interventions Against Muscle Wasting in Cancer Cachexia?

The Redox Balance: A Target for Interventions Against Muscle Wasting in Cancer Cachexia?

Associations of specific postoperative complications with costs after radical cystectomy

Early Complications and Mortality following Radical Cystectomy: Associations with Malnutrition and Obesity

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