Preoperative Nutritional Risk Assessment in Predicting Postoperative Outcome in Patients Undergoing Major Surgery

Introduction Although a variety of nutritional indices have been found to be valuable in predicting patient outcome when used alone, there is no consensus on the best method for assessing the nutritional status of hospitalized patients. Therefore, the aim of this study was to assess the nutritional...

Full description

Saved in:
Bibliographic Details
Published in:World journal of surgery 2006-03, Vol.30 (3), p.378-390
Main Authors: Kuzu, Mehmet A., Terzioğlu, Helin, Genç, Volkan, Erkek, A. Bülent, Özban, Murat, Sonyürek, Pınar, Elhan, Atilla H., Torun, Nusret
Format: Article
Language:English
Subjects:
Biological and medical sciences
Chi-Square Distribution
Elective Surgical Procedures
Female
General aspects
Humans
Male
Medical sciences
Middle Aged
Mini Nutritional Assessment
Nutrition Assessment
Nutritional Assessment
Nutritional Status
Predictive Value of Tests
Preoperative Care
Prognostic Nutritional Index
Prospective Studies
Receiver Operating Characteristic Curve
Risk Assessment
Risk Factors
ROC Curve
Statistics, Nonparametric
Total Lymphocyte Count
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Introduction Although a variety of nutritional indices have been found to be valuable in predicting patient outcome when used alone, there is no consensus on the best method for assessing the nutritional status of hospitalized patients. Therefore, the aim of this study was to assess the nutritional status of a cohort of patients who underwent major elective surgery using the Nutritional Risk Index (NRI), Maastricht Index (MI), Subjective Global Assessment (SGA), and Mini Nutritional Assessment (MNA) to determine the best possible nutrition screening system in surgical practice. Methods The study population consisted of 460 patients who underwent major elective surgery between December 1999 and March 2002. Each patient had a complete set of the three nutritional assessment techniques (NRI, MI, SGA); in addition, the MNA was performed in patients older than 59 years of age. One of the coauthors who was unaware of the nutritional assessments assessed the patients for postoperative morbidity and mortality. Complications were classified as major or minor and as infectious or noninfectious. To assess the predictive value of the assessment techniques, likelihood ratios were calculated for the various strata of each method. The odds ratio and receiver operating characteristic (ROC) curves were also calculated to describe and compare the diagnostic value of each of the four nutrition indices. Results Twenty patients died during the study period. No complications occurred in 329 of the 460 patients; 42 patients suffered from two or more complications. The frequency of malnutrition was found to be 58.3%, 63.5%, and 67.4% as assessed by the SGA, NRI, and MI, respectively. Morbidity rates, especially severe infectious and noninfectious complications, were significantly higher in malnourished patients in all nutritional indices. The likelihood ratio was well correlated with the risk categories of every nutritional index. The area under the ROC curves revealed that each scoring system proved to be significantly powerful in predicting the morbidity (infectious and noninfectious severe morbidity) and mortality. However, no differences were detected among the nutritional indices in 460 patients. The odds ratio for morbidity between the well nourished and malnourished patients was 3.09 [95% confidence interval (CI), 1.96–4.88], 3.47 (95% CI, 2.12–5.68), 2.30 (95% CI, 1.43–3.71), and 2.81 (95% CI, 0.79–9.95) for the SGA, NRI, MI, and MNA, respectively. All indices except the
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-005-0163-1