Relation of Malnutrition on Septic Older Adults in Emergency Gastrointestinal Surgery: A Modified Global Leadership Initiative on Malnutrition Analysis.

INTRODUCTION: Malnutrition in older adults has significant ramifications for surgical outcomes. The incidence of malnutrition is up to 30% in emergent gastrointestinal surgery (EGS). This study aims to investigate malnutrition's correlation on outcomes of older adults with preoperative sepsis undergoing EGS. METHODS: Adults aged ≥ 65 y who had preoperative sepsis were included. The Global Leadership Initiative on Malnutrition (GLIM) introduced criteria to diagnose malnutrition. We used a modified GLIM (mGLIM) using the National Surgical Quality Improvement Project database. The mGLIM includes (1) body mass index ≤ 20 kg/m2 for age ≤ 70 y and body mass index ≤ 22 kg/m2 for age ≥ 71 y, (2) weight loss >10% within the past 6 mo, (3) admission albumin ≤ 3.5 g/dL, and (4) EGS as an acute disease marker. Multivariate regression explored the relationship of malnutrition on mortality, length of stay, and complications. RESULTS: A total of 26,801 patients were included. Demographically, female patients included 58% (n = 15,501). African American patients consisted of 8.0% (n = 2133), and Caucasian patients accounted for 75.7% (n = 20,295) of the study population. Small bowel cases were 32.1% (n = 8609), and colorectal cases represented 76.5% (n = 20,490) of all cases. Malnourished patients made up of 1.8% (n = 481) of all patients. Multivariate regression revealed malnourished patients have higher chance of mortality for small bowel (P = 0.001, confidence interval [CI] 1.31-2.69) and colorectal (P < 0.001, CI 1.47-2.39) procedures, and higher likelihood of complications for colorectal (P = 0.001, CI 1.31-2.65) cases. CONCLUSIONS: Our analysis shows that malnutrition, as identified by mGLIM criteria, is associated with higher mortality and complication rates after EGS. The mGLIM criteria could be a prognostic tool for adverse outcomes in malnutrition-risk patients.

Duke Scholars

Author Krista Lynn Haines Trauma, Acute, and Critical Care Surgery

Author Suresh Kumar Agarwal Jr. Trauma, Acute, and Critical Care Surgery

Author Paul Edmund Wischmeyer Anesthesiology, Critical Care Medicine