Poor Diet Increases Complications After Abdominal Surgery

MUNICH — Suboptimal body weight and poor nutritional status significantly increase the risk for 30-day postoperative morbidity after abdominal surgery, new research suggests.

"The assessment of preoperative nutritional status in surgical patients is not always performed. Our results highlight the fact that it must be routinely assessed in the preoperative setting," said investigator Nicola Pavan, MD, from the University of Miami Miller School of Medicine.

"Using a standardized predictive algorithm to identify, treat, and optimize nutritional status preoperatively may help to reduce the incidence of postoperative complications in patients undergoing abdominal surgery," he told Medscape Medical News.

Dr Pavan presented the study results here at the European Association of Urology 2016 Congress.

He and his colleagues identified 162,364 patients in the National Surgery Quality Improvement Program who underwent one of three major abdominal surgeries from 2009 to 2013. They then developed a predictive model to identify patients at risk for developing complications.

Table. Breakdown of Abdominal Surgeries in the Study Cohort

Procedure	Open Procedure, %	Minimally Invasive Procedure, %
Colectomy	28.7	33.4
Cystectomy	2.3	0.1
Hysterectomy	15.7	19.9

On multivariate analysis, after adjustment for age, sex, smoking, and surgical approach, the researchers identified recent weight loss, body mass index (BMI), and hypoalbuminemia as predictive factors for major complications 30 days after surgery.

The risk for complications was higher in patients who lost more than 10% of their body weight in the 6 months before surgery than in those who did not (odds ratio [OR], 1.14, P < .053).

The risk was higher in patients with a below-normal BMI than in those with a normal BMI (OR, 1.36; P < .0003).

And the risk was higher in patients with moderate hypoalbuminemia (OR, 1.18; P < .01) or severe hypoalbuminemia (OR, 1.93; P <.0001) than in those with normal levels of serum albumin.

It's one thing to define a risk group with malnutrition, but it doesn't necessarily mean that treating it will change the outcome.

"Preoperative nutritional intervention is important for malnourished patients, and in certain clinical settings it has been shown to decrease the incidence of complications by as much as 50%," Dr Pavan told Medscape Medical News.

However, session chair Jonas Hugosson, MD, from the University of Gothenburg in Sweden, expressed some reservations.

"It's one thing to define a risk group with malnutrition, but it doesn't necessarily mean that treating it will change the outcome," he said.

"Many times these are patients with advanced cancers, so the disease they have might be the most important problem," he told Medscape Medical News.

Dr Pavan and Dr Hugosson have disclosed no relevant financial relationships.

European Association of Urology (EAU) 2016 Congress: Abstract 335. Presented March 13, 2016.

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Cite this: Poor Diet Increases Complications After Abdominal Surgery - Medscape - Mar 17, 2016.

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