Malnutrition as a risk factor for post-operative morbidity in gynecologic cancer: Analysis using a national surgical outcomes database

To assess, using a national surgical outcomes database, the association of various malnutrition definitions with post-operative morbidity in three gynecologic malignancies. Patients undergoing resection of ovarian, uterine, or cervical cancer between 2005 and 2019 were identified using the National...

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Veröffentlicht in:Gynecologic oncology Jg. 165; H. 2; S. 309 - 316
Hauptverfasser: Goins, Emily C., Weber, Jeremy M., Truong, Tracy, Moss, Haley A., Previs, Rebecca A., Davidson, Brittany A., Havrilesky, Laura J.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.05.2022
Schlagworte:
Albumin
Albumins
Body mass index
Carcinoma, Ovarian Epithelial
Cervical cancer
Endometrial cancer
Female
Genital Neoplasms, Female - surgery
Gynecologic cancer
Hematology, Oncology, and Palliative Medicine
Humans
Malnutrition
Malnutrition - epidemiology
Morbidity
Obstetrics and Gynecology
Ovarian cancer
Ovarian Neoplasms
Post-operative outcomes
Risk Factors
Treatment Outcome
United States - epidemiology
Uterine cancer
Uterine Cervical Neoplasms - surgery
Weight Loss
United States
Body mass index
Endometrial cancer
Gynecologic cancer
Weight loss
Albumin
Malnutrition
Uterine cancer
Post-operative outcomes
Cervical cancer
Ovarian cancer
ISSN:0090-8258, 1095-6859, 1095-6859
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Zusammenfassung:To assess, using a national surgical outcomes database, the association of various malnutrition definitions with post-operative morbidity in three gynecologic malignancies. Patients undergoing resection of ovarian, uterine, or cervical cancer between 2005 and 2019 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Patients were classified based on specific, pre-defined malnutrition criteria: severe malnutrition (Body Mass Index (BMI) <18.5 + 10% weight loss), European Society for Clinical Nutrition and Metabolism ((ESPEN1); BMI 18.5–22 + 10% weight loss), ESPEN2 (BMI < 18.5), American Cancer Society ((ACS); normal/overweight BMI + 10% weight loss), mild malnutrition (BMI 18.5–22), or albumin (<3.5 g/dL). Outcomes included 30-day major complications, readmission, reoperation. Modified Poisson regression estimated associations between definitions and outcomes. Of 76,290 total patients undergoing surgery, those meeting malnutrition definitions were: severe-98 (0.1%), ESPEN1–148 (0.2%), ESPEN2–877 (1.1%), ACS-1028 (1.3%), mild-2853 (3.7%), and albumin (11.1%). Complication rates were: unplanned readmission-5.5%, reoperation-1.7%, major complications-13.5%. For ovarian cancer, ESPEN2 malnutrition was associated with higher readmissions (risk ratio 1.69; 95% confidence interval 1.29–2.20), reoperations (2.53; 1.70–3.77), and complications (1.36; 1.20–1.54). For uterine cancer, ACS malnutrition was associated with readmissions (2.74; 2.09–3.59), reoperations (3.61; 2.29–5.71) and complications (3.92; 3.40–4.53). For cervical cancer, albumin<3.5 g/dL was associated with readmissions (1.48; 1.01–2.19), reoperations (2.25; 1.17–4.34), and complications (2.59; 2.11–3.17). Albumin<3.5 was associated with adverse outcomes in ovarian and uterine cancer. Preoperative risk assessments might be tailored using cancer-specific malnutrition criteria. Major complications, readmissions, and reoperations are all associated with the ESPEN2 definition for ovarian cancer, the ACS definition for uterine cancer, and with albumin<3.5 for all cancers. [Display omitted] •We used a national surgical database to study malnutrition definitions and post-surgical morbidity in gynecologic cancer.•Patients meeting malnutrition criteria were mild-3.7%, severe-0.1%, ESPEN1–0.2%, ESPEN2–1.1%, and ACS-1.3%.•In uterine cancer, weight loss and albumin were associated with major complications, reoperation, and readmission.•In cervical cancer, only albumin was associated with increased risk of all pre-designated outcomes.•In ovarian cancer, weight loss, low body mass index, and albumin were associated with post-operative adverse outcomes.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0090-8258
1095-6859
1095-6859
DOI:10.1016/j.ygyno.2022.01.030