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Preoperative standardized phase angle at bioimpedance vector analysis predicts the outbreak of
Linda Roccamatisi1, Luca Gianotti1, Salvatore Paiella2
1School of Medicine and Surgery, University of Milano-Bicocca and Department of Surgery, San Gerardo Hospital, Monza, Italy Monza, Italy.
Objectives:
Infectious morbidity is the most common and costly among all surgery-related complications, and infections by multidrug-resistant microorganisms (MDR) are associated with poor outcomes. Derangements of body composition is a recognized risk factor for infections. The aim of this study was to investigate the potential association between specific traits of body composition and the risk of having MDR-related infections.
Methods:
This was a prospective study with patients scheduled for major abdominal surgery for gastrointestinal cancer. Bioimpedance vector analysis (BIVA), a reliable tool for body composition assessment, was performed the day before the operation. Postoperative complications were collected focusing on resistance patterns and site of infection. Patterns of resistance were compared with BIVA parameters.
Results:
Data from 182 patients suffering from pancreatic (n = 76, 41.7%), rectal (n = 38, 20.9%), gastric (n = 31, 17%), or hepatic (n = 37, 20.3%) malignancy were collected. Overall complications occurred in 108 patients (59%), and in 45 patients (28%) bacterial infections were proven at culture. Of these, 15 (8%) were multidrug-sensitive (MDS), 38 MDR, and 2 extended drug-resistant (XDR) infections. The standardized phase angle measured (SPA) at BIVA was significantly lower in the MDR/XDR infections (-0.02 ± 1.20) than for no infection/MDS (0.56 ± 1.53; P = 0.029). A multivariate analysis showed that SPA was the only independent variable for MDR/XDR infections with an odds ratio of 3.057 (95% confidence interval, 1.354-6903; P = 0.007). The predictive ability of SPA revealed an area under the receiver operating characteristic curve of 0.662, with an optimal threshold of -0.3.
Conclusions:
In surgical cancer patients, preoperative value of SPA lower than -0.3 is associated with the outbreak of MDR bacterial infections.
Insights
Preoperative body composition, specifically a low standardized phase angle (SPA), is linked to increased risk of multidrug-resistant (MDR) infections after major abdominal surgery. This finding aids in identifying high-risk surgical cancer patients for targeted interventions.
Area of Science:
- Surgical oncology
- Infectious disease
- Body composition analysis
Background:
- Infectious morbidity is a significant complication in surgery, with multidrug-resistant (MDR) infections leading to poor patient outcomes.
- Alterations in body composition are recognized risk factors for surgical site infections.
- Identifying specific body composition traits associated with MDR infections is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between specific body composition traits and the risk of developing MDR infections in patients undergoing major abdominal surgery for gastrointestinal cancer.
- To determine if preoperative body composition assessment can predict the likelihood of MDR infections.
Main Methods:
- Prospective study involving 182 patients scheduled for major abdominal surgery for gastrointestinal cancer.
- Bioimpedance vector analysis (BIVA) was used for preoperative body composition assessment.
- Postoperative complications, including bacterial infections and resistance patterns, were meticulously recorded and analyzed against BIVA parameters.
Main Results:
- A total of 108 patients (59%) experienced complications, with 45 (28%) developing bacterial infections, including 38 MDR infections.
- The standardized phase angle (SPA) measured by BIVA was significantly lower in patients with MDR/extended drug-resistant (XDR) infections compared to those with no or multidrug-sensitive infections (P=0.029).
- Multivariate analysis identified SPA as the sole independent predictor for MDR/XDR infections (OR=3.057, P=0.007), with an optimal predictive threshold of -0.3.
Conclusions:
- A preoperative standardized phase angle (SPA) below -0.3 is significantly associated with an increased risk of multidrug-resistant (MDR) bacterial infections in surgical cancer patients.
- Preoperative BIVA assessment of body composition, particularly SPA, can serve as a valuable tool for predicting MDR infection risk in this patient population.
