Abstract
Background
Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. This study aimed to determine the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer.
Methods
Multicentre, international prospective cohort study of consecutive patients undergoing elective surgery for colorectal or gastric cancer. Patients were excluded if the primary pathology was benign, they presented with recurrence, or if they underwent emergency surgery. Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression and three-way mediation analysis determined the relationship between country income group, nutritional status and 30-day postoperative outcomes.
Findings
This study included 5709 patients (4593 colorectal; 1116 gastric) from 381 hospitals in 75 countries. The mean age was 68.2 years (standard deviation 12.3) and 41.9% of patients were female (N = 1515). Severe malnutrition was present in one third of all patients, with a disproportionate burden in upper middle (44%, N = 504) and low/lower-middle income countries (63%, N = 601). After adjustment for patient and hospital risk factors, severe malnutrition was associated with 30-day mortality across all country income groups (High: aOR 1.96, 95% confidence interval 1.14 to 3.37, p=0.015; Upper middle: 3.05, 1.45 to 6.42, p=0.003; Low/lower middle: 11.57, 5.87 to 22.80, pInterpretation
Severe malnutrition is common in patients requiring surgery for gastrointestinal cancers and is a risk-factor for 30-day mortality following elective surgery for colorectal or gastric cancer. There is an urgent need to determine whether perioperative nutritional interventions can improve early outcomes following gastrointestinal cancer surgery worldwide.
Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. This study aimed to determine the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer.
Methods
Multicentre, international prospective cohort study of consecutive patients undergoing elective surgery for colorectal or gastric cancer. Patients were excluded if the primary pathology was benign, they presented with recurrence, or if they underwent emergency surgery. Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression and three-way mediation analysis determined the relationship between country income group, nutritional status and 30-day postoperative outcomes.
Findings
This study included 5709 patients (4593 colorectal; 1116 gastric) from 381 hospitals in 75 countries. The mean age was 68.2 years (standard deviation 12.3) and 41.9% of patients were female (N = 1515). Severe malnutrition was present in one third of all patients, with a disproportionate burden in upper middle (44%, N = 504) and low/lower-middle income countries (63%, N = 601). After adjustment for patient and hospital risk factors, severe malnutrition was associated with 30-day mortality across all country income groups (High: aOR 1.96, 95% confidence interval 1.14 to 3.37, p=0.015; Upper middle: 3.05, 1.45 to 6.42, p=0.003; Low/lower middle: 11.57, 5.87 to 22.80, pInterpretation
Severe malnutrition is common in patients requiring surgery for gastrointestinal cancers and is a risk-factor for 30-day mortality following elective surgery for colorectal or gastric cancer. There is an urgent need to determine whether perioperative nutritional interventions can improve early outcomes following gastrointestinal cancer surgery worldwide.
| Original language | English |
|---|---|
| Article number | e341-e349 |
| Number of pages | 21 |
| Journal | The Lancet Global Health |
| Volume | 11 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2023 |
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