title: Nutritional predictors of complications following radical cystectomy.
abstract: OBJECTIVE
  To determine the impact of preoperative nutritional status on the development of surgical complications following cystectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).
  
  
  METHODS
  We performed a retrospective review of the NSQIP 2005-2012 Participant Use Data Files. ACS-NSQIP collects data on 135 variables, including pre- and intraoperative data and 30-day postoperative complications and mortality on all major surgical procedures at participating institutions. Preoperative albumin (<3.5 or >3.5 g/dl), weight loss 6 months before surgery (>10 %), and body mass index (BMI) were identified as nutritional variables within the database. The overall complication rate was calculated, and predictors of complications were identified using multivariable logistic regression models.
  
  
  RESULTS
  A total of 1,213 patients underwent cystectomy for bladder cancer between 2005 and 2012. The overall 30-day complication rate was 55.1 % (n = 668). While 14.7 % (n = 102) had a preoperative albumin <3.5 g/dL, 3.4 % had >10 % weight loss in the 6 months prior to surgery and the mean BMI was 28 kg/m(2). After controlling for age, sex, medical comorbidities, medical resident involvement, operation year, operative time, and prior operation, only albumin <3.5 g/dl was a significant predictor of experiencing a postoperative complication (p = 0.03). This remained significant when albumin was evaluated as a continuous variable (p = 0.02).
  
  
  CONCLUSIONS
  Poor nutritional status measured by serum albumin is predictive of an increased rate of surgical complications following radical cystectomy. This finding supports the importance of preoperative nutritional status in this population and highlights the need for the development of effective nutritional interventions in the preoperative setting.
authors.affiliation: Department of Urology, University of North Carolina at Chapel Hill, 170 Manning Drive, 2113 Physicians Office Building, CB#7235, Chapel Hill, NC, 27599-7235, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Johnson
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Riggs
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Nielsen
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Matthews
authors.forename: Michael E
authors.initials: ME
authors.lastname: Woods
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.forename: Angela B
authors.initials: AB
authors.lastname: Smith
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D015653:Cystectomy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000208:ethnology; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000208:ethnology / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology* / Q000208:ethnology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*; D015431:Weight Loss; D044465:White People / Q000706:statistics & numerical data
chemical_list: D012709:Serum Albumin