Assessing Malnutrition Before Major Oncologic Surgery: One Size Does Not Fit All.

Autor:	McKenna NP; Department of Surgery, Mayo Clinic, Rochester, MN; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. Electronic address: mckenna.nicholas@mayo.edu., Bews KA; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN., Al-Refaie WB; Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC., Colibaseanu DT; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL., Pemberton JH; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN., Cima RR; Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN., Habermann EB; Department of Surgery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2020 Apr; Vol. 230 (4), pp. 451-460. Date of Electronic Publication: 2020 Feb 26.
DOI:	10.1016/j.jamcollsurg.2019.12.034
Abstrakt:	Background: There are multiple definitions for malnutrition, without evidence of superiority of any one definition to assess preoperative risk. Therefore, to aid in identification of patients that might warrant prehabilitation, we aimed to determine the optimal definition of malnutrition before major oncologic resection for 6 cancer types. Methods: The American College of Surgeons NSQIP database was queried for patients undergoing elective major oncologic operations from 2005 to 2017. Nutritional status was evaluated using the European Society for Parenteral and Enteral Nutrition definitions, NSQIP's variable for >10% weight loss during the previous 6 months, and the WHO BMI classification system. Multivariable logistic regression was performed to evaluate the adjusted effect of nutritional status on mortality and major morbidity. Results: We identified 205,840 operations (74% colorectal, 10% pancreatic, 9% lung, 3% gastric, 3% esophageal, and 2% liver). A minority (16%) of patients met criteria for malnutrition (0.6% severe malnutrition, 1% European Society for Parenteral and Enteral Nutrition 1, 2% European Society for Parenteral and Enteral Nutrition 2, 6% NSQIP, and 6% mild malnutrition), 31% were obese, and the remaining 54% had a normal nutrition status. Both mortality and major morbidity varied significantly between the nutrition groups (both p < 0.0001). An interaction between nutritional status and cancer type was observed in the models for mortality and major morbidity (interaction term p < 0.0001 for both), indicating the optimal definition of malnutrition varied by cancer type. Conclusions: The definition of malnutrition used to assess postoperative risk is specific to the type of cancer being treated. These findings can be used to enhance nutritional preparedness in the preoperative setting. (Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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