Prevalence of Malnutrition Among Gastric Cancer Patients Undergoing Gastrectomy and Optimal Preoperative Nutritional Support for Preventing Surgical Site Infections.
BACKGROUND
Malnutrition is an independent risk factor for postoperative mortality and morbidity in major gastrointestinal surgery. The aim of this study was to investigate the prevalence of malnutrition and identify the optimal preoperative nutritional support for preventing postoperative surgical site infections (SSIs) in malnourished gastric cancer patients undergoing gastrectomy.


METHODS
We analyzed 800 patients with gastric cancer who underwent gastrectomy. Nutritional risk factors included weight loss >10 % within 6 months, body mass index <18.5 kg/m(2), Subjective Global Assessment Grade C, and serum albumin <3.0 g/dl. Adequate energy intake was defined as receiving ≥25 kcal/kg ideal body weight per day. Optimal nutritional support was examined in terms of both duration and calorie intake.


RESULTS
Overall, 152 patients (19.0 %) were classified as malnourished. The incidence of SSIs was significantly higher in malnourished patients than in well-nourished patients (35.5 vs. 14.0 %; p < 0.0001). The incidence of SSIs in malnourished patients was significantly lower in the well-supported group receiving adequate energy support for at least 10 days than in the poorly-supported group, which received inadequate or no energy support or adequate energy support for <10 days (17.0 vs. 45.4 %; p = 0.0006). In multivariate analysis, well-managed nutritional support was identified as an independent factor associated with fewer SSIs (odds ratio 0.14; 95 % confidence interval 0.05-0.37; p = 0.0002).


CONCLUSIONS
Malnutrition, a risk factor for SSI, was prevalent in gastric cancer patients preoperatively. Well-managed preoperative nutritional support decreased the incidence of postoperative SSIs in malnourished patients.
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Yasunari
Y
Fukuda
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. kazuy@onh.go.jp.
Kazuyoshi
K
Yamamoto
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Motohiro
M
Hirao
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Kazuhiro
K
Nishikawa
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Sakae
S
Maeda
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Naotsugu
N
Haraguchi
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Masakazu
M
Miyake
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Naoki
N
Hama
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Atsushi
A
Miyamoto
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Masataka
M
Ikeda
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Shoji
S
Nakamori
Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.
Mitsugu
M
Sekimoto
Department of Surgery, Osaka General Medical Center, Osaka, Japan.
Kazumasa
K
Fujitani
Department of Surgery, Kaizuka City Hospital, Osaka, Japan.
Toshimasa
T
Tsujinaka
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009367:Neoplasm Staging; D018529:Nutritional Support; D011183:Postoperative Complications; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*