PREVALENCE OF MALNUTRITION AND ITS OUTCOMES IN PATIENTS UNDERGOING MAJOR

ABDOMINAL SURGERY IN TERTIARY HOSPITALS

Introduction

Malnourished patients are at risk of increased morbidity and mortality. The European Society

for Clinical Nutrition and Metabolism (ESPEN) have provided criteria to diagnose malnutrition.

We aim to determine the prevalence of malnutrition among surgical patients undergoing major

abdominal surgery and the associated adverse outcomes.

Material and Method

Patients who underwent major abdominal surgery from June 2019 to September 2020 were

included and classified by NRS 2002 into well-nourished and malnourished. Patients’

complications throughout the admission was documented until discharge or death.

Result

A total of 150 patients were included. Median age was 53 years, with male 53% and female

47%. The prevalence of malnutrition was 40%. The postoperative complication according to

Clavien Dindo Classification (CDC) was seen in 60% of the cases. These complications were more

frequent (89.2% vs 39.6%) and more severe (CDC III-V 44.1% vs 12.1%, p <0.001) in

malnourished group compared to well-nourished group. Malnourished patients were older (64

vs. 40, p<0.001), predominantly males (p=0.002). Malignancy was the primary diagnosis (p

<0.001). Malnourished patients had higher rate of open surgery (p=0.001), increase and more

severe postoperative complications (CDC III-V 44.1% vs 12.1%, p <0.001). Median stay for

malnourished patients was 15 vs. four days (p=<0.001). Surgical site infection, ventilator usage
and ICU admission were significantly higher in malnourished patient group (47.5 vs. 6.6, p

<0.001 / 25.4 vs. 8.8, p=0.006 / 32.2 vs. 8.8, p<0.001). On multivariate analysis, malnourished

patients had a longer length of stay which was statistically significant (p<0.0001, OR 0.838), a

higher rate of surgical site infection (p=0.043, OR 4.148), and higher complication grade

according to Clavien Dindo Classification (p=0.031, OR 3.424).

Conclusion

Malnutrition is highly associated with elderly patients and malignancies. Policies and strategies

should be implemented to screen, diagnose and integrate care for a malnourished patient as

prevention is cost-effective and leads to a better outcome for patients

Keyword

Prevalence, Malnutrition, Abdominal, Surgery, Complication