title: Malnutrition risk predicts surgical outcomes in patients undergoing gastrointestinal operations: Results of a prospective study.
abstract: OBJECTIVE
  Patients undergoing gastrointestinal operations are at risk of malnutrition which may increase the chance of adverse surgical outcomes. This prospective study aimed at correlating nutritional status of patients having gastrointestinal operations with their short-term surgical outcomes captured by a territory-wide Surgical Outcomes Monitoring and Improvement Program.
  
  
  METHODS
  The preoperative malnutrition risk of Chinese adult patients undergoing elective/emergency ultra-major/major gastrointestinal operations in two surgical departments over a 12-month period were assessed by Chinese version of Malnutrition Universal Screening Tool. Their perioperative risk factors and clinical outcomes, including length of hospital stay, mortality and morbidity, were retrieved from the above mentioned program. Correlation of malnutrition risk with clinical outcomes was assessed by logistic regression analysis after controlling for known confounders.
  
  
  RESULTS
  943 patients (58% male; mean age 65.9 ± 14.8 years) underwent gastrointestinal operations (40.3% emergency operation; 52.7% ultra-major procedures; 66.9% bowel resections) had analyzable data. 15.8% and 17.1% of patients were at medium and high risk of malnutrition, respectively. Malnutrition risk score according to the screening tool was an independent predictor of length of hospital stay, 30-day mortality, 60-day mortality and minor medical complications. Similar correlations were found for various sub-scores of malnutrition risk. Weight loss sub-score was predictive of 30-day mortality, 60-day mortality and minor medical complications. Body mass index was predictive of mortality (30- and 60- day) whereas the acute disease sub-score was predictive of length of hospital stay.
  
  
  CONCLUSIONS
  Preoperative malnutrition was an important predictor of poor clinical outcomes in patients undergoing gastrointestinal operations in Hong Kong.
authors.affiliation: Department of Surgery, Queen Mary Hospital, Hong Kong. Electronic address: judyho@hku.hk.
authors.forename: Judy W C
authors.initials: JW
authors.lastname: Ho
authors.affiliation: Department of Surgery, United Christian Hospital, Hong Kong.
authors.forename: Arthur H W
authors.initials: AH
authors.lastname: Wu
authors.affiliation: Department of Surgery, Queen Mary Hospital, Hong Kong.
authors.forename: Michelle W K
authors.initials: MW
authors.lastname: Lee
authors.affiliation: Department of Surgery, United Christian Hospital, Hong Kong.
authors.forename: So-ying
authors.initials: SY
authors.lastname: Lau
authors.affiliation: Department of Surgery, United Christian Hospital, Hong Kong.
authors.forename: Pui-shan
authors.initials: PS
authors.lastname: Lam
authors.affiliation: Department of Surgery, United Christian Hospital, Hong Kong.
authors.forename: Wai-shan
authors.initials: WS
authors.lastname: Lau
authors.affiliation: Department of Surgery, United Christian Hospital, Hong Kong.
authors.forename: Sam S S
authors.initials: SS
authors.lastname: Kwok
authors.affiliation: Department of Surgery, United Christian Hospital, Hong Kong.
authors.forename: Rosa Y H
authors.initials: RY
authors.lastname: Kwan
authors.affiliation: Department of Surgery, Queen Mary Hospital, Hong Kong.
authors.forename: Cheuk-fan
authors.initials: CF
authors.lastname: Lam
authors.affiliation: Department of Surgery, Queen Mary Hospital, Hong Kong.
authors.forename: Chun-kit
authors.initials: CK
authors.lastname: Tam
authors.affiliation: Department of Surgery, Queen Mary Hospital, Hong Kong.
authors.forename: Suk-on
authors.initials: SO
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D015992:Body Mass Index; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Gastrointestinal surgery; Length of stay; Malnutrition; Mortality; Nutritional screening; Surgical outcomes