Impact of malnutrition on radical nephroureterectomy morbidity and mortality: Opportunity for pre-operative optimization
Nutritional status is increasingly recognized as an important predictor of prognosis and surgical outcomes in cancer patients. We evaluated the impact of preoperative malnutrition on the development of surgical complications and mortality following radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC).
Using data from The American College of Surgeons National Surgical Quality Improvement Program, we evaluated the association of poor nutritional status with 30 day postoperative complications and overall mortality following RNU over years 2005-2015. Preoperative variables suggestive of poor nutritional status included hypoalbuminemia (<3.5 g/dL), weight loss 6 months before surgery (>10%), and low body mass index (BMI). The overall complication rate was calculated, and predictors of complications and mortality were identified using multivariable logistic regression models.
A total of 1,200 patients were identified who underwent RNU for UTUC. The overall complication rate was 20.5% (n=246) and mortality rate was 1.75% (n=21). On univariate analysis, patients who had a postoperative complication were more likely to have hypoalbuminemia (25.0% vs. 11.4% p<0.001) and weight loss (3.7% vs. 1.0% p=0.003). After controlling for age, sex, race and medical comorbidities, hypoalbuminemia was found to be a significant independent predictor of postoperative complications (OR 2.09 95% CI 1.29-3.38 p=0.003), whereas weight loss and BMI were not significant predictors (Figure 1A). Hypoalbuminemia was also found to be significant independent predictor of mortality (OR 4.31 95% CI 1.45-12.79 p=0.008) on multivariable regression analysis (Figure 1B).</p>
Preoperative hypoalbuminemia is a significant predictor of surgical complications and mortality following RNU for UTUC. This finding supports the importance of preoperative nutritional status in this population and suggests that effective nutritional interventions in the preoperative setting could improve patient outcomes.