Fukuda Yasunari, Yamamoto Kazuyoshi, Hirao Motohiro, Nishikawa Kazuhiro, Maeda Sakae, Haraguchi Naotsugu, Miyake Masakazu, Hama Naoki, Miyamoto Atsushi, Ikeda Masataka, Nakamori Shoji, Sekimoto Mitsugu, Fujitani Kazumasa, Tsujinaka Toshimasa
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Department of Surgery, Osaka General Medical Center, Osaka, Japan.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S778-85. doi: 10.1245/s10434-015-4820-9. Epub 2015 Aug 19.
Malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. The aim of this study was to investigate the prevalence of malnutrition and identify the optimal preoperative nutritional support for preventing postoperative surgical site infections (SSIs) in malnourished gastric cancer patients undergoing gastrectomy.
We analyzed 800 patients with gastric cancer who underwent gastrectomy. Nutritional risk factors included weight loss >10 % within 6 months, body mass index <18.5 kg/m(2), Subjective Global Assessment Grade C, and serum albumin <3.0 g/dl. Adequate energy intake was defined as receiving ≥25 kcal/kg ideal body weight per day. Optimal nutritional support was examined in terms of both duration and calorie intake.
Overall, 152 patients (19.0 %) were classified as malnourished. The incidence of SSIs was significantly higher in malnourished patients than in well-nourished patients (35.5 vs. 14.0 %; p < 0.0001). The incidence of SSIs in malnourished patients was significantly lower in the well-supported group receiving adequate energy support for at least 10 days than in the poorly-supported group, which received inadequate or no energy support or adequate energy support for <10 days (17.0 vs. 45.4 %; p = 0.0006). In multivariate analysis, well-managed nutritional support was identified as an independent factor associated with fewer SSIs (odds ratio 0.14; 95 % confidence interval 0.05-0.37; p = 0.0002).
Malnutrition, a risk factor for SSI, was prevalent in gastric cancer patients preoperatively. Well-managed preoperative nutritional support decreased the incidence of postoperative SSIs in malnourished patients.
营养不良是大型胃肠手术术后死亡率和发病率的独立危险因素。本研究的目的是调查营养不良的患病率，并确定在接受胃切除术的营养不良胃癌患者中预防术后手术部位感染（SSI）的最佳术前营养支持。
我们分析了800例接受胃切除术的胃癌患者。营养风险因素包括6个月内体重减轻>10%、体重指数<18.5 kg/m²、主观全面评定C级以及血清白蛋白<3.0 g/dl。充足的能量摄入定义为每天接受≥25 kcal/kg理想体重。从持续时间和热量摄入两方面检查最佳营养支持。
总体而言，152例患者（19.0%）被归类为营养不良。营养不良患者的SSI发生率显著高于营养良好的患者（35.5%对14.0%；p<0.0001）。在接受至少10天充足能量支持的良好支持组中，营养不良患者的SSI发生率显著低于接受不足或无能量支持或接受不足10天充足能量支持的不良支持组（17.0%对45.4%；p = 0.0006）。在多变量分析中，良好管理的营养支持被确定为与较少SSI相关的独立因素（优势比0.14；95%置信区间0.05 - 0.37；p = 0.0002）。
营养不良是SSI的一个危险因素，在胃癌患者术前普遍存在。良好管理的术前营养支持降低了营养不良患者术后SSI的发生率。
