Underweight patients and the risks of major surgery

Abstract

The relation between weight loss and the risks of major surgery have been investigated for more than 50 years. It can now be said, with some confidence, that the underweight patient has an increased risk of complications following major surgery. This understanding, however, is based on methods of nutritional assessment that are of limited relevance to hospitalized patients whose malnutrition might be due to sepsis, neoplasia, trauma, or starvation. A consequence is the widespread belief that protein-energy malnutrition (PEM) has been overemphasized as a surgical risk factor, and that the many nonnutritional risk factors ought to be implicated more often. An argument is made for a fresh approach to nutritional assessment in order to better identify the individual patient who, by virtue of PEM, stands an increased risk of a complicated postoperative course. It is suggested that an evaluation of the impact PEM has on vital physiologic function provides a clinically relevant defect to identify and treat and a means of monitoring response to nutritional intervention.

Changes in Nutritional Status and Postoperative Outcomes in Elderly CABG Patients

“…Weight loss associated with a decrease in body protein is related to a decrease in physiological function (Windsor 1993). In this study, the pathophysiological mechanism for weight loss is not certain.…”

“…along the continuum from optimum to poor nutrition. Nutritional status plays a critical role in the promotion, maintenance, and restoration of health in the elderly (Amella and DiMaria 2001) and is of particular importance in surgical patients (Wilmore 1999), in whom poor nutrition is related to adverse biomedical health outcomes (Klidjian and others 1980;Haydock and Hill 1986;Hirsch and others 1992;Windsor 1993). However, the relationship between nutritional status and general health outcomes, such as self-reported physical health, is not known.…”

Assessment of nutritional status on hospital admission: nutritional scores

“…Although these indicators are epidemiologically useful, there is no gold standard; thus, nutritional evaluation tends to be overlooked, though the presence of malnutrition is likely to affect patient outcomes (Mullen et al, 1979;Yamanaka et al, 1989;Windsor, 1993;Gibbs et al, 1999;Leardi et al, 2000). Body weight, for example, can be inaccurate if edema, ascites or fluid balance derangements are present, resulting in falsely high Body Mass Index (weight (kg)/height (m) 2 ) measurements (Bruun et al, 1999).…”

Obesity and Underweight Are Associated with an Increased Risk of Death after Lung Transplantation

“…Underweight has been linked to a higher risk of death after lung transplantation in single-center studies (7,8), but has not been previously reported as a risk factor for 1-or 5-year mortality in ISHLT registry reports. Nevertheless, underweight is a risk factor for poor outcomes after cardiothoracic (9)(10)(11) and other major surgical procedures (12). Underweight has yet to be examined as a risk factor for death after lung transplantation in large welldesigned studies.…”