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Original Articles
- Development and Internal/External Validation of a Prediction Model for Weight Loss Following Gastric Cancer Surgery: A Multicenter Retrospective Study
- Ji-Hyeon Park, Seong-Ho Kong, Do Joong Park, Han-Kwang Yang, Jong Won Kim, Ki Bum Park, In Cho, Sun-Hwi Hwang, Dong-Wook Kim, Su Mi Kim, Seung-Wan Ryu, Seong Chan Gong, Pil Young Jung, Hoon Ryu, Sung Geun Kim, Chang In Choi, Dae-Hwan Kim, Sung-IL Choi, Ji-Ho Park, Dong Jin Park, Gyu-Yeol Kim, Yunhee Choi, Hyuk-Joon Lee
- Ann Clin Nutr Metab 2022;14(2):55-65. Published online December 1, 2022
- DOI: https://doi.org/10.15747/ACNM.2022.14.2.55
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Abstract
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ePub - Purpose: To develop an individualized model for predicting the extent of unintentional weight loss following gastrectomy in patients with gastric cancer based on related risk factors and to externally validate this model using multicenter clinical data in Korea.
Materials and Methods: Among gastric cancer patients who underwent curative gastrectomy at 14 different gastric cancer centers, clinical data from patients with more than one weight measurement during the three-year follow-up period were retrospectively collected. Risk factors associated with weight loss in gastric cancer patients after gastrectomy were analyzed, and a predictive model was developed. Internal and external validation were performed.
Results: The data from 2,649 patients were divided into a derivation set (n=1,420 from Seoul National University Hospital) and validation set (n=1,229 from 13 different gastric cancers). Postoperative duration (six vs. 12, 24, or 36 months), sex (female vs. male), age, preoperative body mass index, type of surgery (pylorus-preserving vs. total, distal or proximal gastrectomy), and cancer stage (I vs. II or III) were included in the final prediction model. The model showed approximately 20% accuracy in predicting weight loss at each period: R2 at six, 12, 24 and 36 months after gastrectomy in internal validation=0.20, 0.21, 0.17, and 0.18, respectively, and in external validation=0.20, 0.22, 0.18, and 0.18, respectively. Calibration slopes of internal and external validation were 0.95 and 1.0, respectively.
Conclusion: Although predictive accuracy of the model did not reach an acceptable level, repeated external validation measurements showed high reliability. The model may serve as a basic reference in clinical practice.
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- Nutritional Assessment of Critically Ill Patients after Abdominal Surgery and Predisposing Factors of Prolonged ICU Stay after Surgery
- Sung Eun Park, In Kyu Lee, Eun Young Kim
- Surg Metab Nutr 2018;9(2):68-74. Published online December 30, 2018
- DOI: https://doi.org/10.18858/smn.2018.9.2.68
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Abstract
PDFePub
Purpose:
Patients in prolonged intensive care unit stay were vulnerable to malnutrition which deteriorated recovery and postoperative outcomes. The purpose of this study was to evaluate nutritional status in surgical patients entering the intensive care unit, and to identify the risk factors that influence prolonged intensive care unit stay.
Materials and Methods:
From January 2016 to June 2018, 740 patients (age≥18 years) who were admitted to our surgical intensive care unit after abdominal surgery with general anesthesia (≥4 hours) were enrolled. Patients were classified into short-term stay group (≤4 days) and long-term stay group (>4 days). These groups were analyzed and compared with patient factors and postoperative outcomes and the multivariate analysis was performed to assess the risk factors for prolonged intensive care unit stay.
Results:
A total of 119 patients were analyzed. The univariate and multivariate analysis showed that dialysis status (Odds ratio 7.684, 95% confidence interval 1.038∼1.103, P=0.013), total lymphocyte count (Odds ratio 0.999, 95% confidence interval 0.998∼1.000, P=0.047), and intraoperative transfusion (Odds ratio 1.002, 95% confidence interval 1.001∼1.002, P=0.000) were associated with prolonged intensive care unit stay. Lone-term stay group were significantly longer hospital stay and higher hospital morbidity rate than short-term stay group.
Conclusion:
Patients with risk factors of prolonged intensive care unit stay included dialysis status, low total lymphocyte count, a large amount of transfusion would be more interested and the active intervention such as early nutritional evaluation and adequate nutritional support should be needed.
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- Is Postoperative Albumin Level Related with Surgical Site Infection?
- Kyungtae CHO, Sung Woo CHO, Sangchul YUN, Suyeon Park
- Surg Metab Nutr 2018;9(2):59-67. Published online December 30, 2018
- DOI: https://doi.org/10.18858/smn.2018.9.2.59
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Abstract
PDFePub
Purpose:
Surgical site infection (SSI) is a hospital-acquired infection (HAI) associated with increased mortality, length of hospital stay, and cost of hospitalization. The aim of this study was to identify the value of albumin as an indicator of the nutritional status, postoperative C-reactive protein (CRP), and white blood cell (WBC) levels in predicting an outbreak of SSI and SSI-related epidemiology after colorectal surgery and identifying the risk factors for SSI.
Materials and Methods:
A total of 198 patients, who underwent colorectal surgery from September 1, 2015 to December 31, 2016, were included in the study. The patient identity, operation characteristics, and SSI data were analyzed retrospectively by a chart review and national SSI reporting sheet. The relationship of the SSI and clinical data was analyzed statistically, and the SSI detection time and post-operative inflammatory laboratory findings were analyzed individually using cumulative incidence analysis and cause-specific hazard model.
Results:
The incidence of SSI post colorectal surgery was 15.7% (31 out of 198 cases). Chronic renal failure (CRF), open surgery, long operation time, and stoma were identified as significant risk factors for SSI using univariate analysis. The CRF, long operation time, and stoma were significant risk factors according to multivariate analysis. The decrease in albumin on post-operative day (POD)#3 and CRP elevation on POD#4 were related to the early detection of SSI.
Conclusion:
The actual incidence of SSI might be higher than expected, particularly in cases where patients have several clinical and operative factors. In addition, the albumin level and multiple postoperative inflammation tests can be employed as an early predictors of SSI.
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- Analysis of Current Status and Predisposing Factors for Nutritional Support of Patients in Surgical Intensive Care Unit
- Byung Chul Kim, In Kyu Lee, Eun Young Kim
- Surg Metab Nutr 2016;7(2):32-38. Published online December 30, 2016
- DOI: https://doi.org/10.18858/smn.2016.7.2.32
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Abstract
PDFePub
Purpose:
Enteral feeding is strongly recommended for critically ill patients since it can enhance the immunologic function, which serves as a host defense mechanism against inflammation or metabolic response to stress. Herein, we investigated nutritional status and estimated the adequacy of the nutritional supply for acutely ill patients admitted to the surgical intensive care unit (SICU) after a major operation.
Materials and Methods:
From February to October 2016, patients admitted and stayed over 48 hours after major surgical procedures at SICU in Seoul St. Mary’s Hospital were reviewed. The nutritional parameters and surgical outcomes were compared according to the status of nutritional support.
Results:
A total of 220 patients composed of 130 males (59.1%) and 90 females (40.9%) were enrolled, and mean age was 61.4±13.6 years. All patients were classified into two groups according to nutritional status, which was assessed by the ratio of total delivered calories to total required calories (D/R); group A (54 cases, 24.5%, D/R≥0.7) versus group B (166 cases, 75.5%, D/R<0.7). In multivariate analysis, incision in the lower abdomen (Odds Ratio 2.277, P=0.078), absence of NST consultation (Odds Ratio 2.728, P=0.011), and not receive minimal invasive surgery (Odds Ratio 3.518, P=0.001) were independent risk factors associated with poor nutritional status.
Conclusion:
Clinicians should pay more attention to patients who had an incision in the lower abdomen or did not receive minimal invasive surgery or NST consultation, which would be predisposing factors for nutritional insufficiency resulting in postoperative morbidities.
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