术前营养状况对术后结局的影响：老年胰十二指肠切除术患者的老年营养风险指数的见解。
The impact of preoperative nutritional status on postoperative outcomes: an insight from Geriatric Nutritional Risk Index in elderly pancreaticoduodenectomy patients.
机构信息
Division of General Surgery, Department of Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan.
出版信息
BMC Surg. 2024 Apr 5;24(1):100. doi: 10.1186/s12893-024-02397-0.
BACKGROUND
Malnutrition is not uncommon among the elderly undergoing pancreatoduodenectomy (PD) and is related to increased complications. Previous studies have shown that the Geriatric Nutritional Risk Index (GNRI) predicts outcomes in various populations. Nevertheless, the research exploring the correlation between GNRI and postoperative outcomes in PD is scarce. This study aimed to investigate the preoperative malnutrition, as measured by GNRI, on outcomes in elderly patients undergoing PD.
MATERIALS AND METHODS
This retrospective analysis enrolled 144 elderly patients underwent PD for periampullary tumors from November 2016 to December 2021. Patients were stratified based on the GNRI value: high/moderate nutrition risk (GNRI ≤ 92, N = 54), low nutrition risk (92 < GNRI ≤ 98, N = 35), and no nutrition risk (GNRI > 98, N = 55). Perioperative outcomes and postoperative surgical complications were compared between these groups. Univariate and multivariate analyses were performed on major postoperative complications and prolonged postoperative length of stay (PLOS).
RESULTS
Patients in the high/moderate risk group were significantly older, with lower BMI (P = 0.012), higher mortality rate (11.1%, P = 0.024), longer PLOS (P < 0.001), and higher incidence of over grade IIIB complications (37.0%, P = 0.001), Univariate and multivariate analyses showed the high/moderate risk GNRI group (OR 3.61, P = 0.032), increased age (OR 1.11, P = 0.014) and operative time over 8 h (OR 3.04, P = 0.027) were significantly associated with increased major postoperative complications. The high/moderate risk GNRI group was also a significant predictor for prolonged PLOS (OR 3.91, P = 0.002).
CONCLUSIONS
Preoperative GNRI has the potential to be a predictive tool for identifying high-risk elderly patients and monitoring nutritional status preoperatively to improve postoperative surgical outcomes following PD.
背景
营养不良在接受胰十二指肠切除术（PD）的老年人中并不少见，且与并发症增加有关。先前的研究表明，老年营养风险指数（GNRI）可预测各种人群的结局。然而，关于 GNRI 与 PD 术后结局之间相关性的研究很少。本研究旨在探讨接受 PD 的老年患者中，术前 GNRI 评估的营养不良与术后结局的关系。
材料与方法
本回顾性分析纳入了 2016 年 11 月至 2021 年 12 月期间因壶腹周围肿瘤接受 PD 的 144 例老年患者。根据 GNRI 值将患者分层：高/中度营养风险（GNRI≤92，N=54）、低营养风险（92<GNRI≤98，N=35）和无营养风险（GNRI>98，N=55）。比较这些组之间的围手术期结局和术后手术并发症。对主要术后并发症和延长术后住院时间（PLOS）进行单因素和多因素分析。
结果
高/中度风险组患者年龄较大，BMI 较低（P=0.012），死亡率较高（11.1%，P=0.024），PLOS 较长（P<0.001），IIIb 级以上并发症发生率较高（37.0%，P=0.001）。单因素和多因素分析显示，高/中度风险 GNRI 组（OR 3.61，P=0.032）、年龄增加（OR 1.11，P=0.014）和手术时间超过 8 小时（OR 3.04，P=0.027）与主要术后并发症增加显著相关。高/中度风险 GNRI 组也是延长 PLOS 的显著预测因素（OR 3.91，P=0.002）。
结论
术前 GNRI 有可能成为识别高危老年患者的预测工具，并在术前监测营养状况，以改善 PD 后的术后手术结局。
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