Protein-energy malnutrition and worse outcomes after major cancer surgery: A nationwide analysis

Jiewen Jin; Xianying Zhu; Zhantao Deng; Pengyuan Zhang; Ying Xiao; Hedong Han; Yanbing Li; Hai Li

doi:10.3389/fonc.2023.970187

Protein-energy malnutrition and worse outcomes after major cancer surgery: A nationwide analysis

Front Oncol. 2023 Jan 17:13:970187. doi: 10.3389/fonc.2023.970187. eCollection 2023.

Authors

Jiewen Jin¹, Xianying Zhu², Zhantao Deng³, Pengyuan Zhang¹, Ying Xiao², Hedong Han⁴, Yanbing Li¹, Hai Li¹

Affiliations

¹ Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
² Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
³ Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
⁴ Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.

Abstract

Background: Protein-energy malnutrition (PEM) has been recognized as a poor prognostic factor in many clinical issues. However, nationwide population studies concerning the impact of PEM on outcomes after major cancer surgery (MCS) are lacking. We aimed to evaluate the postoperative outcomes associated with PEM following MCS.

Methods: By using the Nationwide Inpatient Sample database, data of patients undergoing MCS including colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy, or prostatectomy were analyzed retrospectively from 2009 to 2015, resulting in a weighted estimate of 1,335,681 patients. The prevalence trend of PEM, as well as mortality and major complications after MCS were calculated. Multivariable regression analysis was applied to estimate the impact of PEM on postoperative outcomes after MCS.

Results: PEM showed an estimated annual percentage increase of 7.17% (95% confidence interval (CI): 4-10.44%) from 2009 to 2015, which contrasts with a 4.52% (95% CI: -6.58-2.41%) and 1.21% (95% CI: -1.85-0.56%) annual decrease in mortality and major complications in patients with PEM after MCS. PEM was associated with increased risk of mortality (odds ratio (OR)=2.26; 95% CI: 2.08-2.44; P < 0.0001), major complications (OR=2.46; 95% CI: 2.36-2.56; P < 0.0001), higher total cost ($35814 [$22292, $59579] vs. $16825 [$11393, $24164], P < 0.0001), and longer length of stay (14 [9-21] days vs. 4 [2-7] days, P < 0.0001), especially in patients underwent prostatectomy, hysterectomy and lung resection.

Conclusions: PEM was associated with increased worse outcomes after major cancer surgery. Early identification and timely medical treatment of PEM for patients with cancer are crucial for improving postoperative outcomes.

Keywords: major cancer surgery; mortality; nationwide analysis; postoperative complications; protein-energy malnutrition (PEM).

Grants and funding

This work was supported by the National Key R&D Program of China (2018YFC1314100), the Key-Area Research and Development Program of Guangdong Province (2019B020230001), the National Natural Science Foundation of China Youth Science Foundation (82201551), the Natural Science Foundation of Guangdong Province (2022A1515011306, 2020A1515010268, 2020A1515010049, 2019A1515010275), the Outstanding Young Talents Foundation of Guangdong Provincial People’s Hospital (KJ012019091), the Program of Science and Technology of Guangzhou (202103020166, 201904010424), NSFC Incubation Project of Guangdong Provincial People’s Hospital(KY0120220031), the Fundamental Research Funds for the Central Universities(2020ZYGXZR010).