Purpose: This study examined the effects of malnutrition on in-hospital mortality after surgery for gastrointestinal (GI) perforation. Materials and Methods: Patients who underwent surgery for GI perforation between 2010 and 2017 were analyzed retrospectively. The preoperative nutritional status was assessed by the Seoul National University Hospital-Nutrition Screening Index, a tool that comprehensively evaluates 11 factors that reflect the nutritional status. The risk factors for in-hospital mortality after surgery for GI perforation were evaluated by univariate and multivariate analyses. Results: Four hundred and eighty-nine patients were divided into two groups: 439 patients in the survival group and 50 patients in the in-hospital mortality group. The risk of malnutrition was higher (93.6% vs. 65.9%, P<0.001) in the in-hospital mortality group than in the survival group. The preoperative albumin level was lower, and the blood urea nitrogen level was higher in the in-hospital mortality group than in the survival group. Emergency surgery, lymphoma as a cause of perforation, and fecal-contaminated ascites were also identified as factors associated with in-hospital mortality. Multivariate analyses demonstrated that a high risk of malnutrition (HR=5.71, 95% CI 1.38~26.02, P=0.017), lymphoma as a cause of perforation (HR=4.12, 95% CI 1.17~14.51, P=0.028), low preoperative albumin (HR=4.77, 95% CI 2.35~9.69, P<0.001), and high preoperative BUN (HR=1.03, 95% CI 1.01~1.05, P=0.001) had significant effects on the in-hospital mortality after surgery for GI perforation. Conclusion: A high risk of malnutrition assessed by the composite index was associated with in-hospital mortality after surgery for a GI perforation.
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Purpose: Bioelectrical impedance analysis (BIA) evaluates body composition and electrical resistance according to weight and height but assumes all limbs are intact. This study evaluated the validity and accuracy of BIA in older amputees with leprosy. Materials and Methods: We evaluated BIA’s effectiveness for determining body composition by measuring muscle mass, water percentage, and physical resistance, including phase angle, in older amputees with leprosy. BIA was performed on 42 individuals with leprosy aged ≥65 years. Comparative analyses were performed by amputation types (left lower limbs, right lower limbs, bilateral lower limbs, and non-amputees). Twenty people without leprosy or amputations of similar age, height, and weight were considered controls. Results: Between the controls, amputee, and the controls without leprosy, BIA showed significant mean differences in skeletal muscle mass (22.5±5.6 kg, 19.6±5.6 kg, 18.2±3.9 kg, respectively; P=0.037); whole-body extracellular water (ECW) ratios (0.410±0.011, 0.401±0.007, 0.393±0.009, respectively; P<0.001) and phase angle (4.2±1.2, 4.4±0.7, 5.0±0.8, respectively; P=0.029). The bilateral lower limb amputation group (median, 0.415; range, 0.407–0.426) showed significantly higher whole-body ECW values than the non-amputee group (median, 0.401, range: 0.391–0.415) (P=0.013). Right leg lean mass was highest in the right lower limb amputation group, followed by bilateral lower limb amputation, non-amputee, and left lower limb amputation groups (median: 9.86, 6.04, 5.02, 3.95, respectively, P=0.001). As the length of the amputated lower limb was shortened, the lower limb's impedance decreased. However, BIA was evaluated without reflecting the shortened length, resulting in an error in the skeletal muscle mass readings. Conclusion: Phase angle, ECW ratio, and bioelectrical impedance vector analysis obtained by BIA appeared accurate, but the skeletal muscle mass showed significant errors for amputated areas.
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Fiziksel Engellilik Vücut Bileşimini Saptamada Engel mi? Betül SUKAN KARAÇAĞIL, Eda KÖKSAL İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi.2023; (19): 314. CrossRef