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Kim, Kim, Lee, Park, Lee, Cho, Kong, and Yang: Impact of Malnutrition Risk Determined by Nutrition Screening Index on Operative Morbidity after Gastric Cancer Surgery
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2011; 80(1): 1-9.

Published online: 27 January 2011

DOI: https://doi.org/10.4174/jkss.2011.80.1.1

Impact of Malnutrition Risk Determined by Nutrition Screening Index on Operative Morbidity after Gastric Cancer Surgery

Yoon Kim, R.D., M.S.1, 2, Won-Gyoung Kim, R.D., M.S.1, 2, Hyuk-Joon Lee, M.D., Ph.D.1, 3, 4, Mi-Sun Park, R.D., M.S.1, 2, Young-Hee Lee, R.D.1, 2, Jae-Jin Cho, R.N.1, Seong-Ho Kong, M.D.1, 3, Han-Kwang Yang, M.D., Ph.D.1, 3, 4

1Nutritional Support Team, Seoul National University Hospital, Seoul, Korea.

2Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea.

3Division of Gastrointestinal Surgery, Seoul National University Hospital, Seoul, Korea.

4Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author (appe98@snu.ac.kr)

Received 19 August 2010       Accepted 2 November 2010

Copyright © 2011 The Korean Surgical Society

Abstract

Purpose

Nutrition status is regarded as an important factor for postoperative morbidity in cancer surgery. The aim of this study was to evaluate the impact of the malnutrition risk, determined by Seoul National University Hospital-Nutrition Screening Index (SNUH-NSI), on operative morbidity after gastrectomy for gastric cancer.

Methods

This study enrolled 246 patients who had undergone gastrectomy for gastric cancer at Seoul National University Hospital from March 2009 to February 2010. We collected general patient information, SNUH-NSI at administration and related parameters (serum albumin, cholesterol, total lymphocyte counts, hemoglobin and body mass index), operative method, hospital stay and operative morbidity.

Results

The patients' mean age was 59.6±11.3 years, and 9.4% (n=23) of patients were rated as severe malnutrition risk. There was no difference in operative morbidity by age or sex. The patients with high risk of malnutrition by SNUH-NSI or with advanced gastric cancer showed higher operative morbidity (P<0.01). There were no relationships between biochemical parameters and operative morbidity. On multivariate analysis, the significant independent risk factors were severe malnutrition by SNUH-NSI (OR 2.627, 95% CI 1.033~6.679; P<0.05) and advanced gastric cancer (OR 2.023, 95% CI 1.074~3.811; P<0.05).

Conclusion

Overall nutritional status, rather than single data, is more related to operative morbidity in gastrectomized patients. Especially severe malnutrition as determined by SNUH-NSI, is an independent risk factor for operative morbidity. Nutritional support to severely malnourished patient by SNUH-NSI is expected to be an effective approach in preventing complications after gastrectomy.

Keywords: Gastric cancer, Gastrectomy, Malnutrition risk, Nutrition screening, Perative morbidity

Figures and Tables

Table 1
Seoul National University Hospital-Nutrition Screening Index (SNUH-NSI)
jkss-80-1-i001

*r = risk factor. High risk group = (more than 2 of r3) or (1 of r3+more than 2 of r2); Low risk group = the others.

Table 2
Definition of complications
jkss-80-1-i002

*CT = computed tomography; †NPO = nothing by month; ‡PCD = percutaneous drainage; §ER = emergency room; ∥GFS = gastrofibroscopy; UGIS = upper gastrointestinal series.

Table 3
General characteristics of the subjects (n=246)
jkss-80-1-i003

*N (%).

Table 4
Incidence of postoperative morbidity
jkss-80-1-i004

*N (%).

Table 5
Univariate analysis of risk factors for postoperative morbidity
jkss-80-1-i005

*SNUH-NSI = Seoul National University Hospital-Nutrition Screening Index.

Table 6
Multivariate analysis of risk factors for postoperative morbidity
jkss-80-1-i006

*SNUH-NSI = Seoul National University Hospital-Nutrition Screening Index.

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