PRE-SURGICAL NUTRITIONAL STATUS AND SURGICAL COMPLICATIONS IN PATIENTS WITH DIGESTIVE AND HEAD AND NECK CANCER
DOI:
https://doi.org/10.34635/rpc.931Keywords:
Malnutrition, Cancer, NRI, Post-surgical outcomesAbstract
Introduction: Malnutrition is present in 40-50% of surgical patients upon hospital admission and is one of the most important factors influencing post-surgical morbidity and mortality. It is important to establish routines to identify and monitor patients at nutritional risk nutritional, to start early nutritional therapy, ideally in the pre-surgical phase. The aim of this study was to evaluate the association between pre-surgical nutritional status and postoperative complications and assess the nutritional assessment tool with the best prognostic value for post-surgical complications, in patients referred to surveillance in intermediate and intensive care units during surgical planning.
Methods: We recruited patients at the Digestive Pathology and Head and Neck Units, referred for surgery and signaled at the anesthesia consultation for post-surgical surveillance in Intermediate or Intensive Care, from August to December 2016, at the Portuguese Institute of Oncology of Porto, Francisco Gentil, EPE. Clinical and demographic data were collected from the clinical process of the patients. Risk and nutritional status assessment was performed in the first 24 hours of patient’s admission to hospital using the PG-SGA and NRI. Data analysis was performed using the SPSS 23.0 statistical program.
Results: We included 97 patients, 62 with digestive malignancies and 35 with head and neck malignant tumors. The prevalence of pre-surgical malnutrition was 51.2% and 33%, as assessed by NRI and PG-SGA, respectively. Nutritional status, as assessed by NRI was associated with postoperative complications and length of hospital stay. Nutritional status and lack of nutritional support were also associated with greater odds of prolonged hospitalizations (>10 days).
Conclusion: The odds of developing post-surgical complications was about 3 times higher if the patient is malnourished or at risk of malnutrition, as assessed by NRI.
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2. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs. 2005;9 Suppl 2:S51-63.
3. Lee A, Oliveira Filho RS, Cardenas TC, Ozório GA, Gropp JPL, Waitzberg DL. Quality control of enteral nutrition therapy in cancer patients at nutritional risk. Nutr Hosp. 2017;34(2):264-70.
4. Suzuki H, Asakawa A, Amitani H, Nakamura N, Inui A. Cancer cachexia--pathophysiology and management. J Gastroenterol. 2013;48(5):574-94.
5. Righini CA, Timi N, Junet P, Bertolo A, Reyt E, Atallah I. Assessment of nutritional status at the time of diagnosis in patients treated for head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis. 2013;130(1):8-14.
6. von Meyenfeldt M. Cancer-associated malnutrition: an introduction. Eur J Oncol Nurs. 2005;9 Suppl 2:S35-8.
7. Hu WH, Cajas-Monson LC, Eisenstein S, Parry L, Cosman B, Ramamoorthy S. Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP. Nutr J. 2015;14:91.
8. Leandro-Merhi VA, Aquino JLB. Relationship between Nutritional Status and the Clinical Outcomes of Patients with and without Neoplasms According to Multiple Correspondence Analysis. Arq Gastroenterol. 2017;54(2):148-55.
9. Leandro-Merhi VA, de Aquino JL. Determinants of malnutrition and post-operative complications in hospitalized surgical patients. J Health Popul Nutr. 2014;32(3):400-10.
10. Leide da Silva Nunes F, Calado Ferreira Pinheiro Gadelha P, Damasceno de Souza Costa M, Carolina Ribeiro de Amorim AC, Bezerra da Silva Mda G. Nutritional status and its impact on time and relocation in postoperative complications of abdominal patients undergoing surgery. Nutr Hosp. 2014;30(3):629-35.
11. Panella L, Jara M, Cornejo M, Lastra X, Contreras MG, Alfaro K, et al. [Nutritional status and postoperative complications in patients with digestive cancer]. Rev Med Chil. 2014;142(11):1398-406.
12. Shpata V, Prendushi X, Kreka M, Kola I, Kurti F, Ohri I. Malnutrition at the time of surgery affects negatively the clinical outcome of critically ill patients with gastrointestinal cancer. Med Arch. 2014;68(4):263-7.
13. Shim H, Cheong JH, Lee KY, Lee H, Lee JG, Noh SH. Perioperative nutritional status changes in gastrointestinal cancer patients. Yonsei Med J. 2013;54(6):1370-6.
14. Schiesser M, Muller S, Kirchhoff P, Breitenstein S, Schafer M, Clavien PA. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr. 2008;27(4):565-70.
15. Gillis C, Buhler K, Bresee L, Carli F, Gramlich L, Culos-Reed N, et al. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology. 2018;155(2):391-410.e4.
16. Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional Risk Screening and Assessment. J Clin Med. 2019;8(7):1065.
17. Kristensen MB, Wessel I, Ustrup KS, Dieperink KB, Zwisler A-D, Beck AM. Nutrition screening and assessment tools for patients with cancer and survivors of cancer: a systematic review protocol. BMJ Open. 2020;10(10):e037844.
18. ASo A. ASA physical status classification system. ASA House of Delegates. 2014.
19. Duarte Bonini Campos JA, Dias do Prado C. Cross-cultural adaptation of the Portuguese version of the Patient-Generated Subjective Global Assessment. Nutr Hosp. 2012;27(2):583-9.
20. Buzby GP, Williford WO, Peterson OL, Crosby LO, Page CP, Reinhardt GF, et al. A randomized clinical trial of total parenteral nutrition in malnourished surgical patients: the rationale and impact of previous clinical trials and pilot study on protocol design. Am J Clin Nutr. 1988;47(2 Suppl):357-65.
21. Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, et al. Prevalence of Malnutrition Among Gastric Cancer Patients Undergoing Gastrectomy and Optimal Preoperative Nutritional Support for Preventing Surgical Site Infections. Ann Surg Oncol. 2015;22 Suppl 3:S778-85.
22. Härter J, Orlandi SP, Gonzalez MC. Nutritional and functional factors as prognostic of surgical cancer patients. Support Care Cancer. 2017;25(8):2525-30.
23. Zheng HL, Lu J, Li P, Xie JW, Wang JB, Lin JX, et al. Effects of Preoperative Malnutrition on Short- and Long-Term Outcomes of Patients with Gastric Cancer: Can We Do Better? Ann Surg Oncol. 2017;24(11):3376-85.
24. Shinkawa H, Takemura S, Uenishi T, Sakae M, Ohata K, Urata Y, et al. Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy. Surg Today. 2013;43(3):276-83.
25. Bo Y, Yao M, Zhang L, Bekalo W, Lu W, Lu Q. Preoperative Nutritional Risk Index to predict postoperative survival time in primary liver cancer patients. Asia Pac J Clin Nutr. 2015;24(4):591-7.
26. Thieme RD, Cutchma G, Chieferdecker ME, Campos AC. Nutritional risk index is predictor of postoperative complications in operations of digestive system or abdominal wall? Arq Bras Cir Dig. 2013;26(4):286-92.
27. Antoun S, Rey A, Béal J, Montange F, Pressoir M, Vasson MP, et al. Nutritional risk factors in planned oncologic surgery: what clinical and biological parameters should be routinely used? World J Surg. 2009;33(8):1633-40.
28. Leandro-Merhi VA, Braga de Aquino JL. Comparison of nutritional diagnosis methods and prediction of clinical outcomes in patients with neoplasms and digestive tract diseases. Clin Nutr. 2015;34(4):647-51.
29. Garth AK, Newsome CM, Simmance N, Crowe TC. Nutritional status, nutrition practices and post-operative complications in patients with gastrointestinal cancer. J Hum Nutr Diet. 2010;23(4):393-401.
30. Jia ZY, Yang J, Tong DN, Peng JY, Zhang ZW, Liu WJ, et al. Screening of nutritional risk and nutritional support in general surgery patients: a survey from Shanghai, China. Int Surg. 2015;100(5):841-8.
31. Montoya Montoya S, Múnera García NE. [Effect of early nutritional intervention in the a outcome of patients at risk clinical nutrition]. Nutr Hosp. 2014;29(2):427-36.
32. Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNM, Delarue J, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005;24(4):502-9.
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