O19 The effect of malnutrition on early outcomes after elective cancer surgery: an international prospective cohort study in 82 countries

Abstract

Abstract Introduction Malnutrition is a key priority on the global health agenda, yet the impact of nutritional state on cancer surgery across income strata remains poorly described. This study aimed to determine the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer. Method Multicentre, international prospective cohort study of consecutive patients undergoing elective surgery for colorectal or gastric cancer. Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression and three-way mediation analysis determined the relationship between country income group, nutritional status and early postoperative outcomes. Result This study included 5709 patients (4593 colorectal; 1116 gastric) from 381 hospitals in 75 countries. Severe malnutrition was present in one third of patients, with a disproportionate burden in upper middle (44%) and low/lower-middle income countries (64%). After adjustment for patient and hospital risk factors, severe malnutrition (aOR 1.62, 95% confidence interval 1.07 to 2.48; P = 0.024) was an independent predictor of 30-day mortality. However, major postoperative complications and surgical site infection rates were similar. Conclusion Severe malnutrition represents a high global burden in cancer surgery, particularly within low-income settings. Malnutrition is an independent risk-factor for 30-day mortality following elective surgery for colorectal or gastric cancer, suggesting perioperative nutritional interventions may improve early outcomes following cancer surgery. Take-home Message Severe malnutrition affects a large proportion of elective surgical oncology patients, with a significantly higher burden in low and middle income countries. Severe malnutrition is independently associated with increased 30-day mortality after cancer surgery.