Evaluation of preoperative nutritional variables to predict postoperative complications after pancreaticoduodenectomy

Perioperative malnutrition reportedly increases postoperative morbidity and mortality rates after abdominal surgery, including pancreaticoduodenectomy (PD). However, few studies have focused on the association between preoperative nutritional variables and the incidence of postoperative complications. The present study aimed to evaluate preoperative nutritional parameters to predict the incidence of postoperative complications after PD.

A total of 140 consecutive patients underwent PD between May 2012 and April 2015. Preoperative nutritional variables included body mass index, total lymphocyte count, albumin, total cholesterol, cholinesterase, and transthyretin. The rates of Clavien-Dindo (C-D) grade ≥II complications were evaluated for each nutritional variable. Predictive factors for the incidence of C-D grade ≥II complications were evaluated by assessing pre- and intraoperative factors.

Of the 140 patients, 108 were included in the study after excluding 32 patients with missing data on preoperative nutritional variables. A cholinesterase concentration of <250 IU/L (odds ratio: 2.82; 95% confidence interval, 1.12-7.80; P = 0.028) was the only independent predictive factor for the incidence of C-D grade ≥II postoperative complications.

Low cholinesterase concentrations were significantly associated with a higher incidence of postoperative morbidity in patients undergoing PD. Preoperative nutritional variables can be used as predictors of postoperative complications after PD.