The clinical impact of malnutrition on the postoperative outcomes of patients undergoing gastrectomy for gastric cancer: Propensity score matched analysis of 2011-2017 hospital database.

BACKGROUND & AIMS: Malnutrition is a prominent feature of gastric cancer patients who suffer from gastric outlet obstruction, impaired peristalsis, and cancer-mediated disruptions in metabolic hemostasis. In this study, we systematically evaluate the impact of malnutrition on the postoperative outcome of patients with gastric cancer undergoing gastrectomy. METHODS: 2011-2017 National Inpatient Sample was used to isolate patients with gastric cancer who underwent gastrectomy, who were stratified using malnutrition. The malnutrition-present cohort was matched to the malnutrition-absent controls using 1:1 propensity score-matching analysis, and compared to the following endpoints: mortality, length of stay (LOS), hospitalization costs, and postoperative complications. RESULTS: 5309 were identified to have undergone gastric resection procedure for gastric cancer, from which there were 1044 with malnutrition and 1044 matched controls. Malnourished patients had higher mortality (6.80 vs 3.83% p = 0.003, OR 1.83 95% CI 1.23-2.73), LOS (17.2 vs 11.4 d p < 0.001), costs ($197,702 vs $124,133 p < 0.001), and were more often discharged to rehabilitation facilities. Malnourished patients had higher rates of wound complications (3.64 vs 1.25% p < 0.001, OR 3.00 95% CI 1.59-5.66), infection (6.90 vs 3.26% p < 0.001, OR 2.20 95% CI 1.45-3.34), and respiratory failure (6.80 vs 3.64% p = 0.002, OR 1.93 95% CI 1.29-2.89). In multivariate analysis, malnourished patients had higher rates of mortality (p = 0.002, aOR 1.87 95% CI 1.25-2.80), length of stay (p < 0.001, aOR 1.52 95% CI 1.48-1.55), costs (p < 0.001, aOR 1.61 95% CI 1.61-1.61) despite controlling for non-matched hospital variables. CONCLUSION: In this propensity score matched analysis, malnutrition is associated with increased postoperative mortality, LOS, and hospitalization costs in patients with gastric cancer undergoing gastric resection surgery.

The clinical impact of malnutrition on the postoperative outcomes of patients undergoing colorectal resection surgery for colon or rectal cancer: Propensity score matched analysis of 2011-2017 US hospitals.

BACKGROUND & AIMS: Malnutrition can be prevalently found in patients with significant-to-advanced colorectal cancer, who potential require colorectal resection procedures; to accurately describe the postoperative risks, we used a propensity-score matched comparison of national database to analyze the effects of malnutrition on post-colectomy outcomes. METHODS: 2011-2017 National inpatient Sample was used to isolate inpatient ceases of colorectal resection procedures, which were stratified using malnutrition into malnutrition-present cohort and malnutrition-absent controls; the controls were propensity-score matched with the study cohort using 1:1 ratio and compared to the following endpoints: mortality, length of stay, costs, postoperative complications. RESULTS: After matching, there were 11357 with and without malnutrition who underwent colorectal resection surgery; in comparison, malnourished patients had higher rates of in-hospital mortality (6.14 vs 3.22% p < 0.001, OR 1.96 95%CI 1.73-2.23), length of stay (15.4 vs 9.61d p < 0.001), costs ($163, 962 vs $102,709 p < 0.001), and were more likely to be discharged to non-routine discharges, including short term hospitals, skilled nursing facilities, and home healthcare. In terms of complications, malnourished patients had higher bleeding (2.87 vs 1.68% p < 0.001, OR 1.73 95%CI 1.44-2.07), wound complications (4.31 vs 1.34% p < 0.001, OR 3.32 95%CI 2.76-3.99), infection (6 vs 2.62% p < 0.001, OR 2.38 95%CI 2.07-2.73), and postoperative respiratory failure (7.27 vs 3.37% p < 0.001, OR 2.25 95%CI 1.99-2.54). CONCLUSION: This study demonstrates the presence of malnutrition to be associated with adverse postoperative outcomes including mortality and complications in patients undergoing colorectal resection surgery for colon cancer.

The clinical impact of cirrhosis on the postoperative outcomes of patients undergoing bariatric surgery: propensity score-matched analysis of 2011-2017 US hospitals.

Objectives: Since there is increasing number of patients with cirrhosis who require the bariatric procedure due to obesity and obesity-related nonalcoholic steatohepatitis fibrosis, we evaluate the effect of cirrhosis on post-bariatric surgery outcomes.Methods: 2011-2017 National Inpatient Sample was used to isolate bariatric cases, which were stratified by cirrhosis; controls were propensity-score matched to cases and compared to endpoints: mortality, length of stay (LOS), costs, and postoperative complications.Results: From 190,753 patients undergoing bariatric surgery, there were 957 with cirrhosis and 957 matched controls. There was no difference in mortality (0.94 vs 0.52% p = 0.42, OR 1.81 95%CI 0.60-5.41); however, cirrhosis patients had higher LOS (3.36 vs 2.89d p = 0.002), costs ($68,671 vs $61,301 p < 0.001), and bleeding (2.09 vs 0.72% p < 0.001, OR 2.95 95%CI 1.89-4.61). In multivariate, there was no difference in mortality (p = 0.330, aOR 1.73 95%CI 0.58-5.19). In subgroup comparison of cirrhosis patients, those with decompensated cirrhosis had higher mortality (7.69 vs 0.94% p < 0.001, OR 8.78 95%CI 3.41-22.59).Conclusion: The results of this study show compensated cirrhosis does not pose an increased risk toward post-bariatric surgery mortality; however, hepatic decompensation increases the postsurgical risks.