Funamizu Naotake, Omura Kenji, Ozaki Takahiro, Honda Masayuki, Mishima Kohei, Igarashi Kazuharu, Takada Yasutsugu, Wakabayashi Go
Department of Surgery, Ageo Central General Hospital, Saitama Prefecture, Japan.
Department of HBP Surgery, Ehime University, Ehime Prefecture, Japan.
Gland Surg. 2020 Dec;9(6):1982-1988. doi: 10.21037/gs-20-451.
Surgical site infections (SSIs), which are associated with preoperative malnutrition, are a well-known potential complication of surgery that leads to increased medical costs and longer hospitalizations. Thus, surgeons need to accurately identify patients at high-risk for SSIs. Considering that the Geriatric Nutritional Risk Index (GNRI) was designed to assess the degree of malnutrition specifically among elderly patients, previous evidence (Kawaguchi study) proved that GNRI predicted the risk of SSIs in patients following pancreatoduodenectomy (PD). In this study, we aimed to validate whether that the same index could predict the risk of SSI among patients who underwent PD in our patient cohort (Ageo study).
The current validation cohort study was retrospectively conducted on 93 patients at the Department of Surgery, Ageo Central General Hospital, Japan, from January 2015 to October 2019. All patients were subjected to nutritional screening using the GNRI and were followed up for the occurrence of postoperative complications. Additionally, risk factors for developing SSI, as well as patient's height, body mass index, and preoperative laboratory values, were recorded.
Patients were divided into the SSI (N=30) and non-SSI (N=63) groups with a determined SSI incidence rate of 32.3% (30/93). The SSI group had significantly lower GNRI than the non-SSI group (P<0.001). Receiver operating characteristic curve analysis determined a cutoff GNRI value of 94 (sensitivity, 83.3%; specificity, 83.6%), similar to that in the previous study. Univariate and multivariate analyses confirmed that a GNRI of <94 was significantly associated with SSI (P<0.001).
The present Ageo study confirmed the consistency of results in Kawaguchi study. Thus, lower GNRI can be a universal marker for SSI risk following PD.
手术部位感染（SSIs）与术前营养不良相关，是一种众所周知的手术潜在并发症，会导致医疗成本增加和住院时间延长。因此，外科医生需要准确识别发生SSIs的高危患者。鉴于老年营养风险指数（GNRI）旨在专门评估老年患者的营养不良程度，先前的证据（川口研究）证明GNRI可预测胰十二指肠切除术（PD）后患者发生SSIs的风险。在本研究中，我们旨在验证同一指数是否能预测我们患者队列中接受PD手术的患者发生SSI的风险（Ageo研究）。
本验证队列研究于2015年1月至2019年10月在日本上尾中央综合医院外科对93例患者进行了回顾性研究。所有患者均使用GNRI进行营养筛查，并对术后并发症的发生情况进行随访。此外，记录了发生SSI的危险因素以及患者的身高、体重指数和术前实验室检查值。
患者分为SSI组（N = 30）和非SSI组（N = 63），确定的SSI发生率为32.3%（30/93）。SSI组的GNRI显著低于非SSI组（P<0.001）。受试者工作特征曲线分析确定GNRI临界值为94（敏感性，83.3%；特异性，83.6%），与先前研究相似。单因素和多因素分析证实，GNRI<94与SSI显著相关（P<0.001）。
目前的Ageo研究证实了川口研究结果的一致性。因此，较低的GNRI可作为PD术后SSI风险的通用标志物。
