title: Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients.
abstract: OBJECTIVE
  Poor nutritional status has been associated with increased postoperative morbidity and mortality in surgical patients. The purpose of this study is to evaluate if decreased nutritional parameters correlate with increased postoperative complications regardless of other risk factors in the gynecologic cancer patient.
  
  
  METHODS
  A retrospective chart review was performed among women who underwent surgical management for gynecologic malignancies from October 2006 to June 2008. Variables included age, race, medical comorbidities, cancer type/stage, preoperative albumin, absolute lymphocyte count (ALC), and body mass index (BMI), estimated blood loss (EBL), intraoperative blood transfusion (BT), intraoperative or postoperative complications, intensive care unit (ICU) admissions, hospital readmissions, reoperations, and cancer recurrence.
  
  
  RESULTS
  Three hundred gynecologic oncology patients with preoperative nutritional parameters were included in the study. Decreased albumin was significantly associated with more postoperative complications (p < 0.001), hospital readmissions (p = 0.01), reoperations (p = 0.03), ICU admissions (p < 0.001), and cancer recurrence (p < 0.001). Decreased ALC and BMI preoperatively was also significantly associated with higher incidence of cancer recurrence (p = 0.01, p = 0.01). Surgical cases involving increased EBL (p = 0.01, p < 0.001) and more BT (p < 0.001, p < 0.001) had significantly more postoperative complications and more ICU admissions. Multivariable logistic regression found preoperative albumin to be an independent predictor of increased postoperative complications.
  
  
  CONCLUSIONS
  Decreased albumin is significantly associated with more postoperative complications, hospital readmissions, reoperations, ICU admissions, and cancer recurrence. This nutritional parameter is an important predictor of postoperative morbidity and mortality. Thus, it is important to assess nutritional status preoperatively and offer nutritional support or alternate treatment options if necessary.
authors.affiliation: Department of Obstetrics and Gynecology, Miller School of Medicine, Jackson Memorial Hospital, University of Miami, 1611 NW 12th Avenue, Holtz Building Suite 4070, Miami, FL 33136, USA. anu.kathiresan@gmail.com
authors.forename: Anupama S Q
authors.initials: AS
authors.lastname: Kathiresan
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Brookfield
authors.forename: Samer I
authors.initials: SI
authors.lastname: Schuman
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Lucci
mesh_terms: D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D015992:Body Mass Index; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery; D003422:Critical Care; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications; D016015:Logistic Models; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009752:Nutritional Status; D010051:Ovarian Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D012709:Serum Albumin