Department of Surgery, Mayo Clinic, Rochester, MN; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Surgical Outcomes Program, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
J Am Coll Surg. 2020 Apr;230(4):451-460. doi: 10.1016/j.jamcollsurg.2019.12.034. Epub 2020 Feb 26.
There are multiple definitions for malnutrition, without evidence of superiority of any one definition to assess preoperative risk. Therefore, to aid in identification of patients that might warrant prehabilitation, we aimed to determine the optimal definition of malnutrition before major oncologic resection for 6 cancer types.
The American College of Surgeons NSQIP database was queried for patients undergoing elective major oncologic operations from 2005 to 2017. Nutritional status was evaluated using the European Society for Parenteral and Enteral Nutrition definitions, NSQIP's variable for >10% weight loss during the previous 6 months, and the WHO BMI classification system. Multivariable logistic regression was performed to evaluate the adjusted effect of nutritional status on mortality and major morbidity.
We identified 205,840 operations (74% colorectal, 10% pancreatic, 9% lung, 3% gastric, 3% esophageal, and 2% liver). A minority (16%) of patients met criteria for malnutrition (0.6% severe malnutrition, 1% European Society for Parenteral and Enteral Nutrition 1, 2% European Society for Parenteral and Enteral Nutrition 2, 6% NSQIP, and 6% mild malnutrition), 31% were obese, and the remaining 54% had a normal nutrition status. Both mortality and major morbidity varied significantly between the nutrition groups (both p < 0.0001). An interaction between nutritional status and cancer type was observed in the models for mortality and major morbidity (interaction term p < 0.0001 for both), indicating the optimal definition of malnutrition varied by cancer type.
The definition of malnutrition used to assess postoperative risk is specific to the type of cancer being treated. These findings can be used to enhance nutritional preparedness in the preoperative setting.
营养不良有多种定义，但没有证据表明任何一种定义都优于评估术前风险。因此，为了帮助确定可能需要进行康复治疗的患者，我们旨在确定 6 种癌症类型的主要肿瘤切除术前最佳营养不良定义。
从 2005 年至 2017 年，美国外科医师学会 NSQIP 数据库中查询接受择期主要肿瘤手术的患者。使用欧洲肠外和肠内营养学会的定义、NSQIP 变量（过去 6 个月体重减轻>10%）和世界卫生组织 BMI 分类系统评估营养状况。采用多变量逻辑回归评估营养状况对死亡率和主要发病率的调整影响。
我们确定了 205840 例手术（74%为结直肠，10%为胰腺，9%为肺，3%为胃，3%为食管，2%为肝）。少数（16%）患者符合营养不良标准（0.6%严重营养不良，1%欧洲肠外和肠内营养学会 1，2%欧洲肠外和肠内营养学会 2，6% NSQIP 和 6%轻度营养不良），31%为肥胖，其余 54%为营养正常。营养组之间的死亡率和主要发病率差异均有统计学意义（均 p <0.0001）。在死亡率和主要发病率模型中观察到营养状况与癌症类型之间存在交互作用（交互项 p <0.0001），表明营养不良的最佳定义因癌症类型而异。
用于评估术后风险的营养不良定义特定于所治疗的癌症类型。这些发现可用于术前增强营养准备。
