O19 The effect of malnutrition on early outcomes after elective cancer surgery: an international prospective cohort study in 82 countries
O19 The effect of malnutrition on early outcomes after elective cancer surgery: an international prospective cohort study in 82 countries
复制标题
O19 营养不良对择期癌症手术后早期结果的影响：一项在 82 个国家进行的国际前瞻性队列研究
作者：
A. Riad;S. Knight;M. Ewen
营养不良是全球卫生议程上的一个关键优先事项，但营养状况对各收入阶层癌症手术的影响仍然没有得到很好的描述。本研究旨在确定结直肠癌或胃癌择期手术后营养不良对术后早期结局的影响。
在接受择期结直肠癌或胃癌手术的连续患者中开展的多中心、国际前瞻性队列研究。营养不良的定义采用全球营养不良领导倡议（GLIM）标准。主要结局为手术后30天内死亡或严重并发症。多水平Logistic回归和三因素中介分析确定了农村收入组、营养状况与术后早期结局的关系。
该研究包括来自75个国家381家医院的5709例患者（4593例结直肠患者; 1116例胃患者）。三分之一的患者存在严重营养不良，中上收入国家（44%）和低收入/中低收入国家（64%）的负担不成比例。校正患者和医院危险因素后，重度营养不良（aOR 1.62，95%置信区间1.07 - 2.48; P = 0.024）是30天死亡率的独立预测因子。然而，主要术后并发症和手术部位感染率相似。
严重营养不良是全球癌症手术的沉重负担，特别是在低收入环境中。营养不良是结直肠癌或胃癌择期手术后30天死亡率的独立危险因素，表明围手术期营养干预可能改善癌症手术后的早期结局。
严重营养不良影响了大部分择期手术肿瘤患者，在低收入和中等收入国家负担明显更高。严重营养不良与癌症手术后30天死亡率增加独立相关。
Malnutrition is a key priority on the global health agenda, yet the impact of nutritional state on cancer surgery across income strata remains poorly described. This study aimed to determine the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer.
Multicentre, international prospective cohort study of consecutive patients undergoing elective surgery for colorectal or gastric cancer. Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression and three-way mediation analysis determined the relationship between country income group, nutritional status and early postoperative outcomes.
This study included 5709 patients (4593 colorectal; 1116 gastric) from 381 hospitals in 75 countries. Severe malnutrition was present in one third of patients, with a disproportionate burden in upper middle (44%) and low/lower-middle income countries (64%). After adjustment for patient and hospital risk factors, severe malnutrition (aOR 1.62, 95% confidence interval 1.07 to 2.48; P = 0.024) was an independent predictor of 30-day mortality. However, major postoperative complications and surgical site infection rates were similar.
Severe malnutrition represents a high global burden in cancer surgery, particularly within low-income settings. Malnutrition is an independent risk-factor for 30-day mortality following elective surgery for colorectal or gastric cancer, suggesting perioperative nutritional interventions may improve early outcomes following cancer surgery.
Severe malnutrition affects a large proportion of elective surgical oncology patients, with a significantly higher burden in low and middle income countries. Severe malnutrition is independently associated with increased 30-day mortality after cancer surgery.