Nutrition is closely associated with cancer prognosis and postoperative outcomes. The Geriatric Nutritional Risk Index (GNRI) is a simple screening tool to predict nutrition-related risk of morbidity and mortality in hospitalized patients. We investigated the value of GNRI to predict postoperative complications after radical cystectomy (RC) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
Using the ACS-NSQIP database from 2011-2019, we identified patients 65 years or older who underwent RC for the treatment of bladder cancer. Based on the original publication describing GNRI, patients were dichotomized into an at-risk GNRI (≤98) group and a no-risk GNRI (>98) group. The following formula was used to calculate GNRI: [1.489 × serum albumin concentration (g/L) + 41.7 × present/ideal body weight (kg)]. Considering the half-life of albumin, only patients with a measurement of albumin 14 days or less before RC were included. Preoperative profiles and 30-day clinical outcomes were then compared between groups. We performed a 1:1 propensity score-matched (PSM) analysis based on demographic and perioperative variables. All statistical analyses were performed using SPSS (v28.0) and R (v4.1.0), with significance set at p < 0.05.
We identified 2,689 eligible patients: 750 in the at-risk GNRI group and 1939 in the no-risk GNRI group (Table 1). Patients in the at-risk group were older, had higher American Society of Anesthesiology (ASA) scores, were more likely to receive preoperative blood transfusion, and less likely to undergo orthotopic neobladder reconstruction. After PSM, patients in the at-risk GNRI group had higher rates of postoperative complication(s) (p = 0.002), mortality (p = 0.031), extended length of stay (p = 0.003), non-home discharge (p = 0.004), transfusion (p < 0.001), and deep venous thrombosis (p = 0.047) (Table 2). We did not find any significant difference in rates of surgical site infection, reoperation, or readmission among the two groups (Table 2).
In our analysis, we demonstrated that the nutritional status of patients undergoing RC impacts postoperative outcomes including mortality. The GNRI is an objective, low-cost, and convenient tool for nutritional status assessment of oncologic patients undergoing RC. Further research is required to understand whether improving the nutritional status prior to RC can improve postoperative outcomes or not.
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THE GERIATRIC NUTRITIONAL RISK INDEX PREDICTS POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH BLADDER CANCER AFTER RADICAL CYSTECTOMY: A PROPENSITY SCORE-MATCHED ANALYSIS OF NSQIP DATA
Bladder Cancer > Other
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Wednesday, Dec 1
4:00 p.m. - 5:00 p.m.
Presented By: Carlos Riveros
Seyed Behzad Jazayeri