Effect of malnutrition on the postoperative outcomes of patients undergoing pancreatectomy for pancreatic cancer: Propensity score–matched analysis of 2011–2017 US hospitals

• Published in: Nutrition in clinical practice 2022-02, Vol.37 (1), p.117-129
• Main Authors: Lee, David Uihwan, Hastie, David Jeffrey, Fan, Gregory Hongyuan, Addonizio, Elyse Ann, Lee, Ki Jung, Han, John, Karagozian, Raffi
• Format: Article
• Language: English
• Subjects: complications; Hospitals; Humans; infections; Length of Stay; malnutrition; Malnutrition - epidemiology; Malnutrition - etiology; mortality; Pancreatectomy - adverse effects; pancreatic cancer; Pancreatic Neoplasms - complications; Pancreatic Neoplasms - surgery; pancreatic resection; pancreaticoduodenectomy; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Propensity Score; Retrospective Studies; Risk Factors; sarcopenia
• ISSN: 0884-5336; 1941-2452
• DOI: 10.1002/ncp.10816

Background Patients with pancreatic cancer suffer from metabolic dysregulation, which can manifest in clinical malnutrition. Because a portion of these patients require cancer‐resective surgery, we evaluate the impact of malnutrition in patients undergoing pancreatic resection using a national database. Methods The 2011–2017 National Inpatient Sample was used to isolate cases of pancreatic resection (partial/total pancreatectomy and radical pancreaticoduodenectomy), which were stratified using malnutrition. A 1:1 nearest‐neighbor propensity‐score matching was applied to match the controls to the malnutrition cohort. End points include mortality, length of stay (LOS), hospitalization costs, and postoperative complications. Results Following the match, there were 2108 with malnutrition and an equal number without; from this, those with malnutrition had higher mortality (4.7% vs 3.04%; P = 0.007; odds ratio [OR], 1.57; 95% CI, 1.14–2.17), longer LOS, and higher costs. Regarding complications, malnourished patients had higher bleeding (5.41% vs 2.99%; P < 0.001; OR, 1.86; 95% CI, 1.36–2.54), wound complications (3.75% vs 1.57%; P < 0.001; OR, 2.45; 95% CI, 1.62–3.69), infection (7.83% vs 3.13%; P < 0.001; OR, 2.63; 95% CI, 1.96–3.52), and respiratory failure (7.45% vs 3.56%; P < 0.001; OR, 2.18; 95% CI, 1.65–2.89). In multivariate analyses, those with malnutrition had higher mortality (P = 0.008; adjust OR, 1.55; 95% CI, 1.12–2.14). Conclusion Those with malnutrition had higher mortality and complications following pancreatic resection; given these findings, it is important that preoperative nutrition therapy is provided to minimize the surgical risks.