Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: A multivariate analysis of 132 patients
Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: A multivariate analysis of 132 patients
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DOI：
10.1016/j.jamcollsurg.2007.02.077
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发表时间：
2007-07-01
影响因子：
5.2
通讯作者：
Popiela, Tadeusz
中科院分区：
文献类型：
--
作者：
Sierzega, Marek;Niekowal, Bogdan;Popiela, Tadeusz
背景资料：虽然营养不良被发现增加手术患者的腹腔内和全身并发症的风险，远端胰腺切除术的数据是稀缺的研究design.Study设计：132例连续患者进行远端胰腺切除术的胰腺病理学的主要程序，1996年和2005年之间的数据进行了审查，以确定术后并发症的危险因素，并确定营养状况的影响。结果：75例（56.8%）患者发生1种或1种以上并发症，其中胰瘘18例（13.6%）。胰瘘患者的NRI中位值（96.9; 95% CI，89.8 - 101.0）显著低于其余受试者（102.5; 95% CI，101.5 - 105.5; p=0.014）。在单变量分析中，NRI（61% vs 30%，p=0.019）和即时营养评估（67% vs 34%，p=0.017）定义的营养不良发生率在发生胰瘘的患者中显著较高。在多变量分析中，营养不良（NRI ≤ 100）是唯一显著增加胰瘘风险的因素，比值比为8.12（95% CI，1.06至22.30）。营养不良，通过由临床和实验室参数组成的综合营养评估量表定义，是胰尾切除术后胰瘘的主要危险因素。
Background: Although malnutrition was found to increase the risk of intraabdominal and systemic complications in surgical patients, data for distal pancreatic resections are scarce.Study Design: Data on 132 consecutive patients undergoing distal pancreatectomy as the primary procedure for pancreatic pathology, between 1996 and 2005, were reviewed to identify risk factors for postoperative complications and determine the impact of nutritional status. Nutritional assessment was performed with clinical and laboratory variables, including unintentional weight loss, body mass index, blood albumin level, lyrnphocyte count, and Nutritional Risk Index (NRI) and Instant Nutritional Assessment (INA) scores.Results: Seventy-five (56.8%) patients developed 1 or more complications, including 18 (13.6%) cases of pancreatic fistula. The median values of NRI were significantly lower in patients with pancreatic fistula (96.9; 95% CI, 89.8 to 101.0) compared with those in the remaining subjects (102.5; 95% CI, 101.5 to 105.5; p=0.014). In the univariate analysis, the incidence of malnutrition defined by NRI (61% versus 30%, p=0.019) and the Instant Nutritional Assessment (67% versus 34%, p=0.017) was significantly higher in patients who developed pancreatic fistula. In the multivariate analysis, malnutrition characterized as NRI of 100 or less was the only factor that significantly increased the risk of pancreatic fistula, with an odds ratio of 8.12 (95% CI, 1.06 to 22.30).Conclusions: Malnutrition, as defined by composite nutritional assessment scales consisting of clinical and laboratory parameters, is a major risk factor for pancreatic fistula after distal pancreatectomy.