Department of Anesthesiology, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
J Anesth. 2023 Jun;37(3):401-407. doi: 10.1007/s00540-023-03178-4. Epub 2023 Mar 16.
Preoperative malnutrition is associated with postoperative complications, prolonged intensive care unit stay, and mortality, leading to functional disability after non-cardiac surgery. However, its effects on cardiac and thoracic aortic surgery outcomes remain unknown. We examined the effects of preoperative malnutrition on disability-free survival after surgery and assessed the perioperative 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS2.0) score based on the preoperative nutritional status.
We included individuals aged ≥ 55 years who underwent elective cardiac and/or thoracic aortic surgery between April 1, 2016 and December 28, 2018 in a tertiary center. The nutritional status was assessed preoperatively using the Mini Nutritional Assessment Short Form, with scores < 12 points indicating a poor nutritional status. The JapanSCORE2 was calculated for surgical risk prediction. Our primary outcome was disability-free survival 1 year after surgery (WHODAS2.0 score: < 16%). The odds ratio of poor nutritional status for disability-free survival was calculated using multiple logistic regression analysis after adjusting for age, JapanSCORE2, and duration of surgery.
One hundred patients were followed up for 1 year. Preoperatively, 41 of them had a poor nutritional status. The disability-free survival rates 1 year postoperatively were 46.3% (19/41) and 64.4% (38/59) in patients with and without poor preoperative nutritional status, respectively. The adjusted odds ratio of poor nutritional status for disability-free survival at 1 year after surgery was 0.42 (95% confidence interval, 0.17-0.99).
Patients with a poor preoperative nutritional status had less likely to show disability-free survival 1 year after cardiac and thoracic aortic surgery.
术前营养不良与术后并发症、重症监护病房住院时间延长和死亡率相关，并导致非心脏手术后出现功能障碍。然而，其对心脏和胸主动脉手术结果的影响尚不清楚。我们研究了术前营养不良对手术后无残疾生存的影响，并根据术前营养状况评估了围手术期 12 项世界卫生组织残疾评估量表 2.0（WHODAS2.0）评分。
我们纳入了 2016 年 4 月 1 日至 2018 年 12 月 28 日在一家三级中心接受择期心脏和/或胸主动脉手术的年龄≥55 岁的个体。术前使用微型营养评估简短表格评估营养状况，得分<12 分表示营养状况不佳。使用日本 SCORE2 进行手术风险预测。我们的主要结局是手术后 1 年无残疾生存（WHODAS2.0 评分：<16%）。使用多因素逻辑回归分析，在校正年龄、日本 SCORE2 和手术持续时间后，计算营养不良状况对无残疾生存的比值比。
100 例患者随访 1 年。术前，41 例患者营养状况不佳。术后 1 年无残疾生存率分别为 46.3%（19/41）和 64.4%（38/59）。术后 1 年调整后的营养不良状况对无残疾生存的比值比为 0.42（95%置信区间，0.17-0.99）。
术前营养状况不佳的患者心脏和胸主动脉手术后 1 年无残疾生存的可能性较小。
