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Comparison of preoperative Nutritional Risk Index and Body Mass Index for predicting immediate postoperative outcomes following major gastrointestinal surgery: Cohort-study.

ABSTRACT: Background:Malnutrition is a major risk factor for morbidity and mortality following gastrointestinal (GI) surgery. Nutritional Risk Index (NRI) and Body Mass Index (BMI) are the two well-validated tools that are readily available and do not add financial burden to the patients. The study aimed to analyze NRI and BMI as a preoperative nutritional indicator of postoperative complications following GI surgeries. Methods:It is an observational study, where preoperative nutritional status and early postoperative complications <30 days (infectious or noninfectious) were studied. The patients admitted between July 2015 to May 2017, who underwent major GI surgeries were included in the study. The correlation between NRI and BMI of these patients were evaluated. Results:The rate of wound infection was 4 (30.7%) out of 13 in severe malnutrition subgroup defined by NRI <83.5 which was found to be statistically significant (p?=?0.003). However, it was not significant in a subgroup of patients with undernutrition defined by BMI <18.49%. In a subgroup analysis, abnormal NRI was found to be statistically significant (p?=?0.004) in patients with malignant disease and malnutrition 64 (47.76%) out of 97 (72.3%). The mean NRI (94.49?±?9.164) better correlated with advancing age (p?

SUBMITTER: Pokharel N

PROVIDER: S-EPMC6838228 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Comparison of preoperative Nutritional Risk Index and Body Mass Index for predicting immediate postoperative outcomes following major gastrointestinal surgery: Cohort-study.

Pokharel Nabin N Katwal Gaurav G Adhikari Subodh Kumar SK

Annals of medicine and surgery (2012) 20191015

<h4>Background</h4>Malnutrition is a major risk factor for morbidity and mortality following gastrointestinal (GI) surgery. Nutritional Risk Index (NRI) and Body Mass Index (BMI) are the two well-validated tools that are readily available and do not add financial burden to the patients. The study aimed to analyze NRI and BMI as a preoperative nutritional indicator of postoperative complications following GI surgeries.<h4>Methods</h4>It is an observational study, where preoperative nutritional st ...[more]

PMID: 31719977

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Project description:ImportancePreoperative hyperglycemia is associated with adverse postoperative outcomes among patients who undergo surgery. Whether preoperative hemoglobin A1c (HbA1c) or postoperative glucose levels are more useful in predicting adverse events following surgery is uncertain in the current literature.ObjectiveTo examine the use of preoperative HbA1c and early postoperative glucose levels for predicting postoperative complications and readmission.Design, setting, and participantsIn this observational cohort study, inpatient gastrointestinal surgical procedures performed at 117 Veterans Affairs hospitals from 2007 to 2014 were identified, and cases of known infection within 3 days before surgery were excluded. Preoperative HbA1c levels were examined as a continuous and categorical variable (<5.7%, 5.7%-6.5%, and >6.5%). A logistic regression modeled postoperative complications and readmissions with the closest preoperative HbA1c within 90 days and the highest postoperative glucose levels within 48 hours of undergoing surgery.Main outcomes and measuresPostoperative complications and 30-day unplanned readmission following discharge.ResultsOf 21 541 participants, 1193 (5.5%) were women, and the mean (SD) age was 63.7 (10.6) years. The cohort included 23 094 operations with measurements of preoperative HbA1c levels and postoperative glucose levels. The complication and 30-day readmission rates were 27.2% and 14.7%, respectively. In logistic regression models adjusting for HbA1c, postoperative glucose levels, postoperative insulin use, diabetes, body mass index (calculated as weight in kilograms divided by height in meters squared), and other patient and procedural factors, peak postoperative glucose levels of more than 250 mg/dL were associated with increased 30-day readmissions (odds ratio, 1.18; 95% CI, 0.99-1.41; P = .07). By contrast, a preoperative HbA1c of more than 6.5% was associated with decreased 30-day readmissions (odds ratio, 0.85; 95% CI, 0.74-0.96; P = .01). As preoperative HbA1c increased, the frequency of 48-hour postoperative glucose checks increased (4.92, 6.89, and 9.71 for an HbA1c <5.7%, 5.7%-6.4%, and >6.5%, respectively; P < .001). Patients with a preoperative HbA1c of more than 6.5% had lower thresholds for postoperative insulin use.Conclusions and relevanceEarly postoperative hyperglycemia was associated with increased readmission, but elevated preoperative HbA1c was not. A higher preoperative HbA1c was associated with increased postoperative glucose level checks and insulin use, suggesting that heightened postoperative vigilance and a lower threshold to treat hyperglycemia may explain this finding.

Dataset Information

Comparison of preoperative Nutritional Risk Index and Body Mass Index for predicting immediate postoperative outcomes following major gastrointestinal surgery: Cohort-study.

Publications

Comparison of preoperative Nutritional Risk Index and Body Mass Index for predicting immediate postoperative outcomes following major gastrointestinal surgery: Cohort-study.

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