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Modified GLIM Status as a Predictor of Morbidity and Mortality After Radical Cystectomy: A Propensity Matched
Elia Abou Chawareb1, Christian H Ayoub1, Adnan El-Achkar1
1Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon.
Introduction:
To assess the modified Global Leadership Initiative on Malnutrition (mGLIM) status as a predictor of postoperative mortality and morbidity in patients undergoing Radical Cystectomy (RC).
Methods And Materials:
The American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to select patients who underwent RC between the years 2011 to 2020. A positive mGLIM status includes patients with preoperative albumin levels < 3.5 g/L or patients with ≥ 10% weight loss over 6 months or BMI ≤ 21 kg/m2. We compared prolonged length of stay, mortality, major morbidity and Clavien-Dindo complications between mGLIM positive and negative patients. A multivariable logistic regression model was also performed to control for possible confounders. Furthermore, a sensitivity analysis was performed by propensity score matching.
Results:
Our cohort consisted of 12,760 patients who underwent RC. The matched cohort yielded 4864 matched patients. After propensity score matching, patients with a positive mGLIM status had higher odds of prolonged length of stay (OR = 1.99, 95%CI [1.75, 2.27]), mortality (OR 1.56, 95%CI [1.08, 2.26]), major morbidity (OR = 1.69, 95%CI [1.51, 1.90]), Clavien-Dindo class I and II (OR = 1.77, 95%CI [1.58, 1.99]), and lower odds of Clavien-Dindo class III (OR = 0.72, 95%CI [0.57, 0.92]) as compared to those with a negative mGLIM status (P < .018).
Conclusion:
A positive mGLIM status is associated with prolonged hospital stay, morbidity, and mortality following RC. This indicates that the mGLIM criteria could serve as an independent predictor of morbidity and mortality in an attempt to optimize patient counseling and preoperative care.
Insights
The modified Global Leadership Initiative on Malnutrition (mGLIM) status predicts worse outcomes after radical cystectomy (RC). Positive mGLIM status is linked to increased mortality, morbidity, and prolonged hospital stays in RC patients.
Area of Science:
- Urology
- Surgical Oncology
- Nutritional Science
Background:
- Malnutrition is a significant concern in surgical patients.
- The modified Global Leadership Initiative on Malnutrition (mGLIM) criteria offer a standardized approach to diagnosing malnutrition.
- Radical cystectomy (RC) is a major surgery with potential for significant postoperative complications.
Purpose of the Study:
- To evaluate the modified Global Leadership Initiative on Malnutrition (mGLIM) status as a predictor of postoperative mortality and morbidity.
- To assess the association between mGLIM status and outcomes following radical cystectomy (RC).
Main Methods:
- Utilized the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset (2011-2020).
- Included patients who underwent radical cystectomy (RC).
- Defined positive mGLIM status by preoperative albumin < 3.5 g/L, weight loss ≥ 10% over 6 months, or BMI ≤ 21 kg/m².
- Compared outcomes (prolonged length of stay, mortality, major morbidity, Clavien-Dindo complications) between mGLIM positive and negative groups.
- Performed multivariable logistic regression and propensity score matching for analysis.
Main Results:
- A cohort of 12,760 patients undergoing RC was analyzed; 4864 were included in the matched cohort.
- Positive mGLIM status was associated with significantly higher odds of prolonged length of stay (OR=1.99), mortality (OR=1.56), and major morbidity (OR=1.69).
- Patients with positive mGLIM status also had higher odds of Clavien-Dindo class I and II complications (OR=1.77) but lower odds of class III complications (OR=0.72).
Conclusions:
- Positive mGLIM status is an independent predictor of adverse outcomes, including prolonged hospital stay, increased morbidity, and mortality after radical cystectomy (RC).
- The mGLIM criteria can aid in identifying high-risk patients.
- Optimizing preoperative nutritional status and counseling based on mGLIM assessment may improve patient care and outcomes.
