The influence of nutritional status on complications after major intraabdominal surgery

Objective: Currently most nutritional assessment techniques are based on their ability to predict clinical outcomes. However, the validity of any of these techniques to truly measure "nutritional risk" has not been proved. We have therefore prospectively assessed the prognostic value of two nutritional assessment techniques and nonnutritional factors in determining outcome after major abdominal surgery. Methods: At admission and discharge, 100 patients undergoing major abdominal surgery were assessed on the following items: Subjective Global Assessment, Nutritional Risk Index, anthropometric measurements, serum total protein, serum albumin, lymphocyte count, total serum cholesterol. Patients were monitored for postoperative complications until death or discharge. Results: At admission, 44% of the patients were malnourished according to the Subjective Global Assessment, while 61% of the patients were malnourished according to the Nutritional Risk Index. At discharge, these numbers were 67% and 82%, respectively. Higher death rates were found in the malnourished groups. The risk of complication was increased in malnourished patients with both assessment techniques. The odds ratios for the association between malnutrition and complications varied between 1.926 and 9.854 with both assessments. The presence of cancer in the patient was predictive for complication. Conclusions: Malnutrition is a marker of bad outcomes. Both Subjective Global Assessment and Nutritional Risk Index nutrition tests are predictive for malnutrition and postoperative complications in patients undergoing major abdominal surgery.