Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne, Lausanne, Switzerland,
Ann Nutr Metab. 2020;76(6):422-430. doi: 10.1159/000514058. Epub 2021 Mar 15.
BMI ≤18.5 kg/m2 and preoperative weight loss may lead to inaccurate assessment of nutritional status, given the increasing prevalence of obesity. The aim of this study was to assess whether clinical evaluation of malnutrition based on these parameters is sufficient to predict complications after colorectal cancer surgery.
The American College of Surgeons-National Quality Improvement Program database was queried from 2005 to 2018. Patients undergoing elective colorectal cancer surgery were divided into 4 groups: (1) albumin <3.1 g/dL within 21 days of surgery, (2) European Society for Clinical Nutrition and Metabolism (ESPEN) 2 clinical parameters for malnutrition (≥10% loss of weight/6 months plus [BMI <20 kg/m2 if age <70 years OR BMI <22 kg/m2 if age ≥70 years]), (3) both aforementioned criteria, and (4) none of aforementioned criteria.
Of 82,280 patients, 5,932 (7.2%) had hypoalbuminemia <3.1 g/dL, 764 (0.9%) fulfilled clinical ESPEN 2 parameters, and 338 (0.4%) met both criteria. After adjusting for baseline confounders, patients in the hypoalbuminemia group had a higher risk of overall complications (odds ratio [OR] 1.92, p < 0.05 vs. OR 1.18 in the ESPEN 2 group, p < 0.05), major complications (OR 1.98, p < 0.05 vs. OR 1.20, p < 0.05), surgical complications (OR 1.77, 95% p < 0.05 vs. OR 1.1, p > 0.05), medical complications (OR 1.73, p < 0.05 vs. OR 1.16, p > 0.05), surgical site infection (OR 1.32, p < 0.05 vs. OR 0.86, p > 0.05), and prolonged hospitalization (OR 1.79, p < 0.05 vs. OR 1.22, p < 0.05). Patients who met both criteria were at highest risk.
Preoperative measurement of serum albumin appears to be essential to identify patients at risk for complications after colorectal cancer surgery. Clinical evaluation through BMI and weight loss alone may underestimate surgery-associated risks in the USA.
BMI≤18.5kg/m2 和术前体重减轻可能导致营养状况评估不准确，因为肥胖的患病率不断增加。本研究的目的是评估基于这些参数的临床营养不良评估是否足以预测结直肠癌手术后的并发症。
从 2005 年到 2018 年，查询美国外科医师学院-国家质量改进计划数据库。接受择期结直肠癌手术的患者分为 4 组：（1）手术前 21 天内白蛋白<3.1g/dL，（2）欧洲临床营养与代谢学会（ESPEN）2 个营养不良临床参数（体重减轻≥10%/6 个月，加上[年龄<70 岁时 BMI<20kg/m2，或年龄≥70 岁时 BMI<22kg/m2]），（3）上述两个标准均符合，以及（4）无上述标准。
在 82280 名患者中，5932 名（7.2%）有低白蛋白血症<3.1g/dL，764 名（0.9%）符合临床 ESPEN 2 标准，338 名（0.4%）符合这两个标准。调整基线混杂因素后，低白蛋白血症组患者总体并发症风险较高（比值比[OR]1.92，p<0.05 vs. OR 1.18 在 ESPEN 2 组，p<0.05），主要并发症（OR 1.98，p<0.05 vs. OR 1.20，p<0.05），手术并发症（OR 1.77，95%置信区间[CI]p<0.05 vs. OR 1.10，p>0.05），医疗并发症（OR 1.73，p<0.05 vs. OR 1.16，p>0.05），手术部位感染（OR 1.32，p<0.05 vs. OR 0.86，p>0.05）和住院时间延长（OR 1.79，p<0.05 vs. OR 1.22，p<0.05）。符合两个标准的患者风险最高。
术前测量血清白蛋白似乎对于识别结直肠癌手术后发生并发症的风险患者至关重要。仅通过 BMI 和体重减轻进行临床评估可能会低估美国手术相关风险。
