European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications
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ORIGINAL SCIENTIFIC REPORT
European Society for Clinical Nutrition and Metabolism (ESPEN) Malnutrition Criteria for Predicting Major Complications After Hepatectomy and Pancreatectomy Yasuyuki Fukami1 • Takuya Saito1 • Takashi Arikawa1 • Takaaki Osawa1 • Shunichiro Komatsu1 Kenitiro Kaneko1 • Yuria Ishida2 • Keisuke Maeda2,3 • Naoharu Mori2,3 • Tsuyoshi Sano1
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Accepted: 16 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Recently, diagnostic criteria for malnutrition have been proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN). This study aimed to investigate the utility of the ESPEN malnutrition criteria as a predictor for major complications following hepatectomy and pancreatectomy. Methods Data were reviewed from 176 consecutive patients who underwent hepatectomy (n = 103) or pancreatectomy (n = 73) between November 2017 and December 2019. Patients were divided into two groups according to the ESPEN malnutrition criteria using a prospectively collected database. The clinical data and the surgical outcomes of patients in the malnourished and normal groups were retrospectively analyzed. Results Thirty-five (20%) patients were diagnosed with malnourishment according to ESPEN criteria. The malnourished group had a significantly low preoperative albumin concentration (p = 0.001). After hepatectomy, major complications (Clavien grade C 3a) occurred significantly more frequently in the malnourished group than in the normal group (p = 0.013). Multivariate analysis indicated that operative duration C 300 min (hazard ratio: 22.47, 95% CI: 2.17 to 232.73, p = 0.009) and malnourishment (hazard ratio: 14.56, 95% CI: 2.58 to 82.17, p = 0.002) were independently associated with major complications after hepatectomy. On the other hand, malnutrition was not associated with major complications after pancreatectomy. Conclusions The ESPEN malnutrition criteria are a valuable predictor for major complications following hepatectomy.
Introduction
& Yasuyuki Fukami [email protected] 1
Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Aichi, Japan
2
Department of Nutrition, Aichi Medical University, Nagakute, Aichi, Japan
3
Department of Palliative and Supportive Medicine, Aichi Medical University, Nagakute, Aichi, Japan
Surgical resection is a standard treatment for hepatopancreatobiliary (HPB) malignancies [1–4]. Although hepatectomy and pancreatectomy have become safe surgeries with low mortality rates due to improvements in surgical techniques and perioperative management, postoperative morbidity rates remain high [5, 6]. Postoperative complications are risk factors for prolonged hospital stays and increased costs of care in surgical patients [7, 8]. Therefore, minimizing postoperative complications can potentially reduce medical costs and improve patient quality of life.
123
World J Surg
Malnutrition is a well-known risk factor for postoperative complications after abdomina
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