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Observational Study
. 2022 Jan 3;14(1):207.
doi: 10.3390/nu14010207.

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

Cristina Martínez-Escribano  1   2 , Francisco Arteaga Moreno  2 , Marcos Pérez-López  2 , Cristina Cunha-Pérez  2 , Ángel Belenguer-Varea  2   3 , David Cuesta Peredo  2   4 , Francisco Javier Blanco González  5 , Francisco J Tarazona-Santabalbina  2   3   6
Affiliations
Observational Study

Malnutrition and Increased Risk of Adverse Outcomes in Elderly Patients Undergoing Elective Colorectal Cancer Surgery: A Case-Control Study Nested in a Cohort

Cristina Martínez-Escribano et al. Nutrients. .

Abstract

Background: Malnutrition increases worse outcomes during hospital admission for elective colorectal cancer (CRC) surgery in older adults.

Methods: This work was designed an observational, monocentric, case-control study nested in a cohort of patients undergoing elective surgery for CRC disease at the Hospital Universitario de la Ribera (HULR) (Alzira, Valencia, Spain) between 2011 and 2019. The study considered patients with a CONUT score in the range of moderate to severe malnutrition (>4 points), with control patients with normal nutritional situations or mild malnutrition.

Results: Moderate-to-severe malnutrition cases presented a greater length of stay (LOS), a higher incidence of adverse events (both medical and surgical complications), a higher incidence of surgical-wound infection, a greater need for blood transfusion, and a greater amount of transfused packed red blood cells. During hospitalization, the percentage of patients without nutritional risk decreased from 46 to 9%, and an increase in mild, moderate, and severe risk was observed. Patients with severe nutritional risk at hospital admission had significantly increased mortality at 365 days after discharge (HR: 2.96 (95% CI 1.14-7.70, p = 0.002)). After adjusting for sex, age, and Charlson index score, patients with severe nutritional risk at admission maintained a higher mortality risk (HR: 3.08 (95% CI 1.10-8.63, p = 0.032)).

Conclusion: Malnutrition prevalence is high in older adults undergoing CRC elective surgery. Furthermore, this prevalence increases during hospital admission. Malnutrition is linked to worse outcomes, such as LOS, surgical and clinical complications, and mortality. For this reason, nutritional interventions are very important in the perioperative period.

Keywords: ERAS; colorectal surgery; malnutrition; older patients; postoperative complications.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Changes in nutritional risk estimated by CONUT score.
Figure 2
Figure 2
Survival curve using the Kaplan-Meier analysis based on the nutritional status estimated by CONUT. (A) Survival curve with the nutritional estimate using CONUT at hospital admission. (B) Analysis with the nutritional estimate using CONUT at hospital discharge.
Figure 2
Figure 2
Survival curve using the Kaplan-Meier analysis based on the nutritional status estimated by CONUT. (A) Survival curve with the nutritional estimate using CONUT at hospital admission. (B) Analysis with the nutritional estimate using CONUT at hospital discharge.
See this image and copyright information in PMC

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