A nutritional screening threshold for optimal outcomes after Hartmann's reversal

Area of Science:

• Colorectal surgery
• Surgical outcomes
• Nutritional science

Background:

• Assessing nutritional status preoperatively is vital for surgical patients.
• The impact of malnutrition on outcomes following Hartmann's reversal (HR) remains under-evaluated.
• Preoperative nutritional screening tools exist but their application to HR is not well-defined.

Purpose of the Study:

• To determine the prevalence of malnutrition risk in patients undergoing HR.
• To evaluate the association between preoperative malnutrition and postoperative outcomes.
• To identify malnutrition as a predictor of adverse events after HR.

Main Methods:

• Analysis of elective HR procedures from 2012-2019 using ACS-NSQIP data.
• Patients classified as malnourished based on BMI < 18.5 kg/m², albumin < 3.5 g/dL, or >10% body weight loss.
• Bivariate and multivariable logistic regression analyses performed to assess outcomes.

Main Results:

• 1762 out of 8878 (20%) HR patients were classified as malnourished.
• Malnourished patients exhibited significantly higher 30-day mortality (OR=2.72, p<0.001) and wound infection rates (OR=1.19, p=0.028).
• Malnourishment was also linked to increased reintubation, bleeding, sepsis, and reoperation rates.

Conclusions:

• A significant proportion of patients undergoing HR are at high risk for malnutrition.
• Malnutrition is an independent predictor of adverse postoperative outcomes, including mortality and surgical site infections.
• Routine preoperative nutritional screening and optimization are recommended for patients undergoing HR.