Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer: an analysis of ACS-NSQIP.
BACKGROUND
Nutritional status is an important factor in predicting the risk associated with surgery for cancer patients. This is especially true in colorectal cancer. Many nutritional assessments are used in clinical practice, but those assessments are rarely evaluated for their ability to predict postoperative outcome.


METHODS
This is a retrospective, multi-institutional study of the ACS-NSQIP database, investigating preoperative nutrition status and its association with postoperative mortality and morbidity.


RESULTS
The prevalence of malnutrition is higher in colorectal cancer, when compared with other most common cancers. Among 42,483 colorectal cancer patients postoperative mortality was significantly associated with hypoalbuminemia (hazard ratio = 3.064, p < 0.001), body weight loss (hazard ratio = 1.229, p = 0.033) and body mass index of <18.5 kg/m(2) (hazard ratio = 1.797, p < 0.001). Only hypoalbuminemia significantly predicted all postoperative complications, even in further multivariate logistic regression analyses (p < 0.001). Multiple regression analysis showed that the hypoalbuminemia group had the highest coefficient in significant association with length of total hospital stay (B = 3.585, p < 0.001) and overall complication (B = 0.119, p < 0.001).


CONCLUSIONS
In colorectal cancer, malnutrition significantly contributes to postoperative mortality, morbidity and length of total hospital stay. Hypoalbuminemia, with levels below 3.5 g/dl, serves as an excellent assessment tool and preoperative predictor of postoperative outcomes.
Department of Surgery, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. gary.hu0805@msa.hinet.net.|Department of Surgery and Rebecca and John Moores Cancer Center, School of Medicine, University of California, San Diego Health System, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA. gary.hu0805@msa.hinet.net.|Department of Colorectal Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. gary.hu0805@msa.hinet.net.
Wan-H
WH
Hu
Department of Surgery, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. lcajas@AD.UCSD.EDU.
Luis C
LC
Cajas-Monson
Department of Surgery, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. seisenstein@mail.ucsd.edu.|Department of Surgery and Rebecca and John Moores Cancer Center, School of Medicine, University of California, San Diego Health System, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA. seisenstein@mail.ucsd.edu.
Samuel
S
Eisenstein
Department of Surgery, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. lparry@mail.ucsd.edu.|Department of Surgery and Rebecca and John Moores Cancer Center, School of Medicine, University of California, San Diego Health System, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA. lparry@mail.ucsd.edu.
Lisa
L
Parry
Department of Surgery, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. bcosman@ucsd.edu.|Department of Surgery, Veteran's Administration San Diego Healthcare System, La Jolla, CA, USA. bcosman@ucsd.edu.
Bard
B
Cosman
Department of Surgery, School of Medicine, University of California, San Diego Health System, La Jolla, CA, USA. sramamoorthy@mail.ucsd.edu.|Department of Surgery and Rebecca and John Moores Cancer Center, School of Medicine, University of California, San Diego Health System, 3855 Health Sciences Drive, La Jolla, CA, 92093, USA. sramamoorthy@mail.ucsd.edu.
Sonia
S
Ramamoorthy
D015992:Body Mass Index; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D034141:Hypoalbuminemia / Q000175:diagnosis / Q000453:epidemiology*; D007902:Length of Stay; D016015:Logistic Models; D044342:Malnutrition / Q000175:diagnosis*; D009017:Morbidity; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
D012709:Serum Albumin