Effects of preoperative nutritional status on disability-free survival after cardiac and thoracic aortic surgery: a prospective observational study

• Published in: Journal of anesthesia Vol. 37; no. 3; pp. 401 - 407
• Main Authors: Kawanishi, Hideaki, Ida, Mitsuru, Naito, Yusuke, Kawaguchi, Masahiko
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01-06-2023; Springer
• Subjects: Analysis; Anesthesiology; Cardiac Surgical Procedures; Critical Care Medicine; Emergency Medicine; Humans; Intensive; Malnutrition - complications; Medicine; Medicine & Public Health; Mortality; Nutrition; Nutrition Assessment; Nutritional Status; Original Article; Pain Medicine; Postoperative Complications - epidemiology; Product/Service Evaluations; Prospective Studies; Risk Factors; Treatment Outcome; Functional status; Cardiac surgical procedures; Aorta; Thoracic; Malnutrition; Disability evaluation
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-023-03178-4

Purpose
Preoperative malnutrition is associated with postoperative complications, prolonged intensive care unit stay, and mortality, leading to functional disability after non-cardiac surgery. However, its effects on cardiac and thoracic aortic surgery outcomes remain unknown. We examined the effects of preoperative malnutrition on disability-free survival after surgery and assessed the perioperative 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS2.0) score based on the preoperative nutritional status.
Methods
We included individuals aged ≥ 55 years who underwent elective cardiac and/or thoracic aortic surgery between April 1, 2016 and December 28, 2018 in a tertiary center. The nutritional status was assessed preoperatively using the Mini Nutritional Assessment Short Form, with scores < 12 points indicating a poor nutritional status. The JapanSCORE2 was calculated for surgical risk prediction. Our primary outcome was disability-free survival 1 year after surgery (WHODAS2.0 score: < 16%). The odds ratio of poor nutritional status for disability-free survival was calculated using multiple logistic regression analysis after adjusting for age, JapanSCORE2, and duration of surgery.
Results
One hundred patients were followed up for 1 year. Preoperatively, 41 of them had a poor nutritional status. The disability-free survival rates 1 year postoperatively were 46.3% (19/41) and 64.4% (38/59) in patients with and without poor preoperative nutritional status, respectively. The adjusted odds ratio of poor nutritional status for disability-free survival at 1 year after surgery was 0.42 (95% confidence interval, 0.17–0.99).
Conclusion
Patients with a poor preoperative nutritional status had less likely to show disability-free survival 1 year after cardiac and thoracic aortic surgery.