Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study
Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study
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DOI：
10.1016/s2214-109x(22)00550-2
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发表时间：
2023-02-14
影响因子：
34.3
通讯作者：
Harrison, Ewen M.
中科院分区：
文献类型：
--
作者：
Riad, Aya M.;GlobalSurg Collaborative, N. I. H. R. Global Health Unit on Global;Harrison, Ewen M.
背景 营养不良是全球卫生政策的一个关键优先事项，但营养状况对全球癌症手术的影响仍然鲜为人知。我们的目的是分析营养不良对结直肠癌或胃癌择期手术后早期术后结果的影响。方法 我们对 2018 年 4 月 1 日至 2019 年 1 月 31 日期间接受结直肠癌或胃癌择期手术的患者进行了一项国际、多中心、前瞻性队列研究。如果原发病理为良性、出现癌症复发或接受了急诊手术（入院 72 小时内）的患者则被排除。营养不良是根据营养不良标准全球领导倡议来定义的。主要结局是手术后 30 天内死亡或主要并发症。采用多级逻辑回归和三向中介分析来建立国家收入组、营养状况和术后 30 天结果之间的关系。结果 这项研究纳入了来自 75 个国家 381 家医院的 5709 名患者（4593 名结直肠癌患者和 1116 名胃癌患者）。平均年龄为 64middot8 岁（SD 13middot5），2432 名患者（42middot6%）为女性。 1899 年，5709 名患者中存在严重营养不良（33middot3%），其中中高收入国家（1135 名患者中的 504 名[44middot4%]）和低收入和中低收入国家（962 名患者中的 601 名[62middot5%]）负担不成比例。调整患者和医院风险因素后，在所有国家收入组中，严重营养不良与 30 天死亡率风险增加相关（高收入：调整后优势比 [aOR] 1middot96 [95% CI 1middot14-3middot37]，p=0middot015；中上收入：3middot05 [1middot45-6middot42]， p=0middot003;低收入和中低收入：11middot57 [5middot87-22middot80]，p < 0middot0001）。严重营养不良导致了低收入和中低收入国家 32% 的早期死亡 (aOR 1middot41 [95% CI 1middot22-1middot64]) 和中高收入国家 40% 的早期死亡 (1middot18 [1middot08-1middot30])。解释 严重营养不良在接受胃肠癌手术的患者中很常见，也是结直肠癌或胃癌择期手术后 30 天死亡的危险因素。迫切需要检查围手术期营养干预是否可以改善全球胃肠癌手术后的早期结果。版权所有 (c) 2023 作者。
Background Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. We aimed to analyse the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer. Methods We did an international, multicentre, prospective cohort study of patients undergoing elective surgery for colorectal or gastric cancer between April 1, 2018, and Jan 31, 2019. Patients were excluded if the primary pathology was benign, they presented with cancer recurrence, or if they underwent emergency surgery (within 72 h of hospital admission). Malnutrition was defined with the Global Leadership Initiative on Malnutrition criteria. The primary outcome was death or a major complication within 30 days of surgery. Multilevel logistic regression and a three-way mediation analysis were done to establish the relationship between country income group, nutritional status, and 30-day postoperative outcomes. Findings This study included 5709 patients (4593 with colorectal cancer and 1116 with gastric cancer) from 381 hospitals in 75 countries. The mean age was 64middot8 years (SD 13middot5) and 2432 (42middot6%) patients were female . Severe malnutrition was present in 1899 (33middot3%) of 5709 patients, with a disproportionate burden in upper-middle-income countries (504 [44middot4%] of 1135) and low-income and lower-middle-income countries (601 [62middot5%] of 962). After adjustment for patient and hospital risk factors, severe malnutrition was associated with an increased risk of 30-day mortality across all country income groups (high income: adjusted odds ratio [aOR] 1middot96 [95% CI 1middot14-3middot37], p=0middot015; upper-middle income: 3middot05 [1middot45-6middot42], p=0middot003; low income and lower-middle income: 11middot57 [5middot87-22middot80], p < 0middot0001). Severe malnutrition mediated an estimated 32% of early deaths in low-income and lower-middle-income countries (aOR 1middot41 [95% CI 1middot22-1middot64]) and an estimated 40% of early deaths in upper-middle-income countries (1middot18 [1middot08-1middot30]). Interpretation Severe malnutrition is common in patients undergoing surgery for gastrointestinal cancers and is a risk factor for 30-day mortality following elective surgery for colorectal or gastric cancer. There is an urgent need to examine whether perioperative nutritional interventions can improve early outcomes following gastrointestinal cancer surgery worldwide.Copyright (c) 2023 The Author(s).