title: Risk factors, complications and survival after upper abdominal surgery: a prospective cohort study.
abstract: BACKGROUND
  Preoperative weight loss and abnormal serum-albumin have traditionally been associated with reduced survival. More recently, a correlation between postoperative complications and reduced long-term survival has been reported and the significance of the relative proportion of skeletal muscle, visceral and subcutaneous adipose tissue has been examined with conflicting results. We investigated how preoperative body composition and major non-fatal complications related to overall survival and compared this to established predictors in a large cohort undergoing upper abdominal surgery.
  
  
  METHODS
  From 2001 to 2006, 447 patients were included in a Norwegian multicenter randomized controlled trial in major upper abdominal surgery. Patients were now, six years later, analyzed as a single prospective cohort and overall survival was retrieved from the National Population Registry. Body composition indices were calculated from CT images taken within three months preoperatively.
  
  
  RESULTS
  Preoperative serum-albumin <35 g/l (HR = 1.52, p = 0 .014) and weight loss >5 % (HR = 1.38, p = 0.023) were independently associated with reduced survival. There was no association between any of the preoperative body composition indices and reduced survival. Major postoperative complications were independently associated with reduced survival but only as long as patients who died within 90 days were included in the analysis.
  
  
  CONCLUSIONS
  Our study has confirmed the robust significance of the traditional indicators, preoperative serum-albumin and weight loss. The body composition indices did not prove beneficial as global indicators of poor prognosis in upper abdominal surgery. We found no association between non-fatal postoperative complications and long-term survival.
authors.affiliation: Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, 9038, Breivika, Norway. eirik.kjus.aahlin@unn.no.|Institute of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway. eirik.kjus.aahlin@unn.no.
authors.forename: E K
authors.initials: EK
authors.lastname: Aahlin
authors.affiliation: Department of Gastrointestinal Surgery, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: G
authors.initials: G
authors.lastname: Tranø
authors.affiliation: Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: N
authors.initials: N
authors.lastname: Johns
authors.affiliation: Department of Abdominal and Emergency Surgery, Haukeland University Hospital, Bergen, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Horn
authors.affiliation: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: J A
authors.initials: JA
authors.lastname: Søreide
authors.affiliation: Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: K C
authors.initials: KC
authors.lastname: Fearon
authors.affiliation: Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, 9038, Breivika, Norway.|Institute of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Revhaug
authors.affiliation: Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, 9038, Breivika, Norway.|Institute of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Lassen
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001823:Body Composition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D015996:Survival Rate; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D012709:Serum Albumin