title: Pre-operative unintentional weight loss as a risk factor for surgical outcomes after elective surgery in patients with disseminated cancer.
abstract: BACKGROUND
  With improvement in survival, elective surgical procedures are being increasingly performed on patients with metastatic disease. We aimed to study the association of pre-operative unintentional weight loss (UWL) with operative outcomes in this patient population.
  
  
  METHODS
  We extracted data on all patients with disseminated cancer undergoing elective surgeries between 2005 and 2011 from the National Surgical Quality Improvement Program (NSQIP), along with the Current Procedure Terminology (CPT) codes. Based on the presence of unintentional weight loss of >10% body weight in the 6-month period preceding surgery, patients were divided into 2 cohorts - (1) patients with UWL ('UWL' cohort) and (2) patients without UWL ('No UWL') cohort. Differences in patient characteristics, co-morbid conditions and outcomes were compared.
  
  
  RESULTS
  There were 30,669 surgeries recorded under 1,638 CPT codes, with 8,436 surgeries involving the eight most common CPT codes. UWL was present in 11.5% of all patients. UWL patients were more commonly (P < 0.05) male, African-American, of higher ASA (American Society of Anesthesiology) class, and had multiple associated comorbidities. Nearly all complications, including wound infections, prolonged ventilator requirement, unplanned intubation, cardiac arrest, DVT, sepsis and mortality were more common in UWL patients. Multivariate analysis demonstrated that UWL was independently associated with 21%, 22% and 49% higher risk of overall morbidity, serious morbidity and 30-day mortality, respectively.
  
  
  CONCLUSIONS
  UWL is an independent risk factor associated with increased morbidity and mortality following elective surgeries in patients with disseminated cancer.
authors: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, United States.
authors: Pragatheeshwar
authors: P
authors: Thirunavukarasu
authors: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, United States.
authors: Sartaj
authors: S
authors: Sanghera
authors: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, United States.
authors: Smit
authors: S
authors: Singla
authors: Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, United States.
authors: Kristopher
authors: K
authors: Attwood
authors: Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, United States. Electronic address: Steven.Nurkin@Roswellpark.org.
authors: Steven
authors: S
authors: Nurkin
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D017558:Elective Surgical Procedures / Q000592:standards*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss
keywords: Disseminated cancer; NSQIP; Operative outcomes; Unintentional weight loss