Protein-energy malnutrition and worse outcomes after major cancer surgery: A nationwide analysis

Abstract

BackgroundProtein-energy malnutrition (PEM) has been recognized as a poor prognostic factor in many clinical issues. However, nationwide population studies concerning the impact of PEM on outcomes after major cancer surgery (MCS) are lacking. We aimed to evaluate the postoperative outcomes associated with PEM following MCS.MethodsBy using the Nationwide Inpatient Sample database, data of patients undergoing MCS including colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy, or prostatectomy were analyzed retrospectively from 2009 to 2015, resulting in a weighted estimate of 1,335,681 patients. The prevalence trend of PEM, as well as mortality and major complications after MCS were calculated. Multivariable regression analysis was applied to estimate the impact of PEM on postoperative outcomes after MCS.ResultsPEM showed an estimated annual percentage increase of 7.17% (95% confidence interval (CI): 4-10.44%) from 2009 to 2015, which contrasts with a 4.52% (95% CI: -6.58–2.41%) and 1.21% (95% CI: -1.85–0.56%) annual decrease in mortality and major complications in patients with PEM after MCS. PEM was associated with increased risk of mortality (odds ratio (OR)=2.26; 95% CI: 2.08-2.44; P < 0.0001), major complications (OR=2.46; 95% CI: 2.36-2.56; P < 0.0001), higher total cost ($35814 [$22292, $59579] vs. $16825 [$11393, $24164], P < 0.0001), and longer length of stay (14 [9-21] days vs. 4 [2-7] days, P < 0.0001), especially in patients underwent prostatectomy, hysterectomy and lung resection.ConclusionsPEM was associated with increased worse outcomes after major cancer surgery. Early identification and timely medical treatment of PEM for patients with cancer are crucial for improving postoperative outcomes.

Association between protein‐energy malnutrition and healthcare use among adult patients after liver transplantation: A retrospective cohort study

“…Prior data have found increased postoperative complications and costs for other major surgeries. 7,8,[10][11][12] A study using the NIS to assess major cancer surgeries found that protein-energy malnutrition was associated with an increased risk of mortality and major complications. 8 Protein-energy malnutrition was also associated with a higher total cost ($35,814 [95% CI, $22,292-$59,579] vs $16,825 [95% CI, $11,393-$24,164]; P < 0.001) and longer hospital length of stay (14 [9][10][11][12][13][14][15][16][17][18][19][20][21] days vs 4 [2-7] days; P < 0.001), particularly in patients undergoing prostatectomy, hysterectomy, and lung resection.…”

“…In the United States, liver transplantation rates and the total cost of liver transplantation-related hospitalizations have increased over time, particularly among older adult patients and patients with more comorbidities. 6 Protein-energy malnutrition has been associated with postsurgical complications in many fields, including surgeries for gastrointestinal malignancies 7,8 and cardiac 9,10 and vascular surgeries. 11,12 Malnutrition has been associated with poor postsurgical outcomes among patients undergoing liver transplantation; however, the financial effect of protein-energy malnutrition on liver transplantation has not been well characterized.…”

Association between underweight status and chylothorax after esophagectomy for esophageal cancer: A propensity score–matched analysis

“… 1 In addition, malnutrition may increase risk of certain clinical outcomes due to compromised immune function, including increased risk of sepsis, heart failure, or poor wound healing. 13 , 14 In this study, the ICD-10 diagnosis of malnutrition was excluded from analyses as a potential risk factor following esophagectomy. This exclusion was due to significant collinearity between underweight status and malnutrition (data not shown), and because malnutrition could not be discerned as a preoperative comorbidity versus a postoperative complication in the NRD.…”

Anticancer restrictive diets and the risk of psychological distress: Review and perspectives

“…26 In the hospital setting, malnourished patients are twice as likely as well-nourished patients to receive antibiotics for an infection, have longer lengths of stay, higher rates of hospital readmission, significantly worse surgical outcomes, and higher mortality rates, in addition to increased healthcare costs. 27,28 Restrictive diets can contribute to weight loss, thereby promoting the development of malnutrition, and prolonged avoidance of certain types of foods, such as dairy or animal products, may cause vitamin or mineral deficiencies, if micronutrients are not adequately supplemented. Consequently, restrictive diets carry an inherent risk of worsening rather than improving the prognosis of cancer patients; in extreme cases, unmonitored restrictive diets can even lead to death.…”

“…In particular, approximately 10%–20% of patients die as a result of malnutrition rather than cancer 26 . In the hospital setting, malnourished patients are twice as likely as well‐nourished patients to receive antibiotics for an infection, have longer lengths of stay, higher rates of hospital readmission, significantly worse surgical outcomes, and higher mortality rates, in addition to increased healthcare costs 27,28 …”