Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study
- PMID: 36796981
- DOI: 10.1016/S2214-109X(22)00550-2
Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study
Abstract
Background: Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. We aimed to analyse the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer.
Methods: We did an international, multicentre, prospective cohort study of patients undergoing elective surgery for colorectal or gastric cancer between April 1, 2018, and Jan 31, 2019. Patients were excluded if the primary pathology was benign, they presented with cancer recurrence, or if they underwent emergency surgery (within 72 h of hospital admission). Malnutrition was defined with the Global Leadership Initiative on Malnutrition criteria. The primary outcome was death or a major complication within 30 days of surgery. Multilevel logistic regression and a three-way mediation analysis were done to establish the relationship between country income group, nutritional status, and 30-day postoperative outcomes.
Findings: This study included 5709 patients (4593 with colorectal cancer and 1116 with gastric cancer) from 381 hospitals in 75 countries. The mean age was 64·8 years (SD 13·5) and 2432 (42·6%) patients were female . Severe malnutrition was present in 1899 (33·3%) of 5709 patients, with a disproportionate burden in upper-middle-income countries (504 [44·4%] of 1135) and low-income and lower-middle-income countries (601 [62·5%] of 962). After adjustment for patient and hospital risk factors, severe malnutrition was associated with an increased risk of 30-day mortality across all country income groups (high income: adjusted odds ratio [aOR] 1·96 [95% CI 1·14-3·37], p=0·015; upper-middle income: 3·05 [1·45-6·42], p=0·003; low income and lower-middle income: 11·57 [5·87-22·80], p<0·0001). Severe malnutrition mediated an estimated 32% of early deaths in low-income and lower-middle-income countries (aOR 1·41 [95% CI 1·22-1·64]) and an estimated 40% of early deaths in upper-middle-income countries (1·18 [1·08-1·30]).
Interpretation: Severe malnutrition is common in patients undergoing surgery for gastrointestinal cancers and is a risk factor for 30-day mortality following elective surgery for colorectal or gastric cancer. There is an urgent need to examine whether perioperative nutritional interventions can improve early outcomes following gastrointestinal cancer surgery worldwide.
Funding: National Institute for Health Research Global Health Research Unit.
Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests AMR reports grant support from the Royal College of Surgeons (Intercalated Bachelor of Science in Surgery Award 2020). RJES reports grant support from NHS Research Scotland. MIvBH reports grant support from Stryker outside the submitted work; all fees were paid to their institution. PB reports grants and personal fees from the UK Medical Research Council, grants from the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme, and the Wellcome Trust, and personal fees from AG Biotest, outside the submitted work. TPK reports personal fees from Olympus Surgical outside the submitted work. ET declares grants from Cancer Research UK. TMD reports research funding from Aligos Therapeutics and Iterion Therapeutics for research unrelated to the submitted work. MDP-S reports personal fees from Abbott Laboratories, Fresenius Kabi, and Otsuka, outside the submitted work. NS reports personal fees from Gore and Medtronic, outside the submitted work. SS reports support from AOA Dx Industry, outside the submitted work. TGW reports support from Wellcome Leap, outside the submitted work. MW reports personal fees from Medtronic, outside the submitted work. All other authors declare no competing interests.
Comment in
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Malnutrition after cancer surgery in low-income and middle-income countries.Lancet Glob Health. 2023 Mar;11(3):e302-e303. doi: 10.1016/S2214-109X(23)00022-0. Lancet Glob Health. 2023. PMID: 36796964 No abstract available.
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