Assessing Malnutrition Before Major Oncologic Surgery: One Size Does Not Fit All

Area of Science:

• Oncology
• Nutritional Science
• Surgical Risk Assessment

Background:

• Multiple definitions of malnutrition exist, with no consensus on the best method for assessing preoperative risk.
• Identifying patients at risk of malnutrition is crucial for implementing prehabilitation strategies before major surgery.

Purpose of the Study:

• To determine the optimal definition of malnutrition for predicting preoperative risk in patients undergoing major oncologic resection across six cancer types.

Main Methods:

• Utilized the American College of Surgeons NSQIP database (2005-2017) for 205,840 major oncologic operations.
• Assessed nutritional status using European Society for Parenteral and Enteral Nutrition (ESPEN) criteria, NSQIP weight loss variable, and WHO BMI classifications.
• Employed multivariable logistic regression to analyze the impact of nutritional status on mortality and major morbidity.

Main Results:

• 16% of patients met malnutrition criteria, with significant variations in mortality and major morbidity across nutrition groups (p < 0.0001).
• An interaction between nutritional status and cancer type was observed (p < 0.0001), indicating that the optimal malnutrition definition differs by cancer type.
• Prevalence of malnutrition varied: 0.6% severe, 1% ESPEN 1, 2% ESPEN 2, 6% NSQIP, 6% mild malnutrition.

Conclusions:

• The optimal definition for assessing malnutrition-related postoperative risk is cancer-specific.
• These findings support tailored nutritional preparedness strategies in the preoperative setting for oncologic patients.