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

Abstract

BackgroundNutritional 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.MethodsThis is a retrospective, multi-institutional study of the ACS-NSQIP database, investigating preoperative nutrition status and its association with postoperative mortality and morbidity.ResultsThe 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/m2 (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).ConclusionsIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12937-015-0081-5) contains supplementary material, which is available to authorized users.

Prehabilitation for adults diagnosed with cancer: A systematic review of long‐term physical function, nutrition and patient‐reported outcomes

“…Given the rising proportion of cancer patients who are obese at diagnosis, the prehabilitive window and rehabilitative window are potentially an opportunity to embed new lifestyle behaviours. Malnutrition is associated with a poorer response to cancer treatment, and hypoalbuminaemia is associated with postsurgical mortality, increased morbidity and length of stay (Hu et al, 2015). Patients with colorectal cancer are more malnourished than other patients groups (28% colorectal compared to 4% prostate cancer) (Hu et al, 2015) hence the wide number of prehabilitation studies in this population.…”

“…Malnutrition is associated with a poorer response to cancer treatment, and hypoalbuminaemia is associated with postsurgical mortality, increased morbidity and length of stay (Hu et al, 2015). Patients with colorectal cancer are more malnourished than other patients groups (28% colorectal compared to 4% prostate cancer) (Hu et al, 2015) hence the wide number of prehabilitation studies in this population. In the nutrition components of prehabilitation programmes, surrogate measures were used for the combined interventions rather than specific targets such as serum values or anthropometric measures.…”

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

“…Other research has established that malnutrition is independently associated with poor clinical outcomes among hospitalized patients, including longer hospital stay, increased costs, increased morbidity, and increased mortality, regardless of the underlying disease [2021]. Nutritional status can be evaluated by using tools such as the Subjective Global Assessment [2223], the Mini Nutritional Assessment [24], and the Malnutrition Clinical Characteristics [25] tools.…”

The Prognostic Prediction Role of Preoperative Serum Albumin Level in Patients with Intahepatic Cholangiocarcinoma Following Hepatectomy

“…On the other hand, malnutrition has been reported to be associated with poor prognosis in several cancers [29, 30]. Serum ALB is one of the mostly commonly used markers for assessing patients’ nutritional status.…”