Can bioimpedance vector analysis (BIVA) predict the surgical risk in cancer patients undergoing pancreatic surgery?

Abstract

Introduction: Bioimpedance vector analysis (BIVA) is a validated tool for the assessment of body composition and hydration index. Several perioperative conditions, such as sarcopenia, sarcopenic obesity and hyperhydration, have been associated with adverse postoperative outcomes after pancreatic surgery. Aim of our study was to evaluate the usefulness of BIVA in the assessment of perioperative risk in cancer patients undergoing pancreatic resection. Methods: We performed a multicentric prospective observational study, including consecutive adult patients undergoing pancreatic surgery at 3 Italian Academic Medical Centers. Exclusion criteria were chronic kidney failure, ASA score >3 and diagnosis of compartmentalized fluid collection. BIVA was measured prior to surgery and on postoperative day 1. Results: Among 104 patients, 64 (61.5%) had any-grade postoperative complications and 10 (9.7%) experienced major morbidity. The preoperative value of the standardized phase angle (SPA) was significantly lower in patients who experienced severe postoperative morbidity than who did not (- 0.60±1.13 vs. 0.56±1.64, p = 0.043). The predictive ability of SPA was investigated by the c-statistic (AUC = 0.728) and the optimal cut-point value was assessed at -0.55. The values of specific resistance (Rz/H), specific reactance (Xc/H) and the Hydration Index (HI) on postoperative day 1 were significantly different in patients who either experienced medical complications, or not [Rz/H (Ω/m): 279.52.5±53.58 vs. 249.89±39.85, p = 0.041; Xc/H (Ω/m): 23.61±9.21 vs. 18.33±5.06, p = 0.027 and HI: 78.2% (73.9-81.6) vs. 82.7% (77.7-87.4), p = 0.034]. Conclusions: Perioperative BIVA assessment predicts the onset of major and medical postoperative complications in pancreatic cancer patients.