title: Effect of preoperative nutritional deficiency on mortality after radical cystectomy for bladder cancer.
abstract: OBJECTIVE
  Poor preoperative nutritional status is a risk factor for adverse outcomes after major surgery. We evaluated the effect of preoperative nutritional deficiency on perioperative mortality and overall survival in patients undergoing radical cystectomy for bladder cancer.
  
  
  METHODS
  A total of 538 patients underwent radical cystectomy for urothelial carcinoma between January 2000 and June 2008, and had nutritional parameters documented. Patients with preoperative albumin less than 3.5 gm/dl, body mass index less than 18.5 kg/m(2) or preoperative weight loss greater than 5% of body weight were considered to have nutritional deficiency. Primary outcomes were 90-day mortality and overall survival. Survival was estimated using Kaplan-Meier analysis and compared using the log rank test. Cox proportional hazards models were used for multivariate survival analysis.
  
  
  RESULTS
  Of 538 patients 103 (19%) met the criteria for nutritional deficiency. The 90-day mortality rate was 7.3% overall (39 deaths), with 16.5% in patients with nutritional deficiency and 5.1% in the others (p < 0.01). Nutritional deficiency was a strong predictor of death within 90 days on multivariate analysis (HR 2.91; 95% CI 1.36, 6.23; p < 0.01). Overall survival at 3 years was 44.5% (33.5, 54.9) for nutritionally deficient patients and 67.6% (62.4, 72.2) for those who were nutritionally normal (p < 0.01). On multivariate analysis nutritional deficiency cases had a significantly higher risk of all cause mortality (HR 1.82; 95% CI 1.25, 2.65; p < 0.01).
  
  
  CONCLUSIONS
  Nutritional deficiency, as measured by preoperative weight loss, body mass index and serum albumin, is a strong predictor of 90-day mortality and poor overall survival. Prospective studies are needed to demonstrate the best indices of preoperative nutritional status and whether nutritional intervention can alter the poor prognosis for patients treated with radical cystectomy who have nutritional deficiencies.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Gregg
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Sharon
authors.initials: S
authors.lastname: Phillips
authors.forename: Shady
authors.initials: S
authors.lastname: Salem
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
authors.forename: Rodney
authors.initials: R
authors.lastname: Davis
authors.forename: C J
authors.initials: CJ
authors.lastname: Stimson
authors.forename: Monty
authors.initials: M
authors.lastname: Aghazadeh
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*