Abstract
Background Clinically relevant postoperative pancreatic fistula (CR-POPF) is a severe complication which may be caused by a perioperative nutrition problem. We aimed to study whether patients with high nutritional risk (NRS2002 score ≥ 5) might benefit from preoperative nutrition support regarding the risk of CR-POPF after open pancreaticoduodenectomy. Methods Consecutive patients undergoing open pancreaticoduodenectomy with complete record of NRS2002 at two Chinese institutions between 2013 and 2018 were analysed. CR-POPF was diagnosed following the 2016 ISGPS criteria. Nutrition support included oral nutrition supplement and enteral and parenteral nutrition. Clinical and economic outcomes were analysed. Results 522 cases were included. 135 cases (25.9%) were at high nutritional risk (NRS2002 score ≥ 5), among which 41 cases (30.4%) received preoperative nutrition support. The CR-POPF rate was significantly lower in the preoperative nutrition support group compared with the no nutrition support group (12.2% versus 28.7%, P = 0.038). Multivariate analysis showed that preoperative nutrition support was a protective factor for CR-POPF in patients at high risk [OR 0.339, 95% CI (0.115-0.965), P = 0.039]. Higher albumin and a larger diameter of the main pancreatic duct were found to be other protectors for CR-POPF. Conclusions Patients with high nutritional risk (NRS2002 score ≥ 5) may profit from preoperative nutritional support manifested in the reduction of CR-POPF.
Highlights
The clinically relevant postoperative pancreatic fistula (CRPOPF) is one of the major causes of morbidity after pancreaticoduodenectomy (PD) [1,2,3], and many risk factors were reported including preoperative factors such as jaundice, pathologic factors such as the pancreatic duct width, and nutritional factors such as body mass index (BMI) and malnutrition [4, 5]
Pancreatic duct stents were preserved in 276 cases (52.9%), but there was no difference in the prevalence of Clinically relevant postoperative pancreatic fistula (CR-POPF) with the nonstent cases (18.5% vs. 23.7%, P = 0:311)
Nutritional Risk Screening 2002 (NRS2002) contains the evaluation of weight loss, BMI, reduction of food intake, severity of disease, and age, each of which was proven to be risk factors of postoperative complications of pancreatectomy [29, 30]
Summary
The clinically relevant postoperative pancreatic fistula (CRPOPF) is one of the major causes of morbidity after pancreaticoduodenectomy (PD) [1,2,3], and many risk factors were reported including preoperative factors such as jaundice, pathologic factors such as the pancreatic duct width, and nutritional factors such as body mass index (BMI) and malnutrition [4, 5]. Some studies in gastrointestinal surgery showed that preoperative nutrition support might improve the postoperative outcomes in the patients with. We aimed to study whether patients with high nutritional risk (NRS2002 score ≥ 5) might benefit from preoperative nutrition support regarding the risk of CR-POPF after open pancreaticoduodenectomy. 135 cases (25.9%) were at high nutritional risk (NRS2002 score ≥ 5), among which 41 cases (30.4%) received preoperative nutrition support. Multivariate analysis showed that preoperative nutrition support was a protective factor for CR-POPF in patients at high risk [OR 0.339, 95% CI (0.115-0.965), P = 0:039]. Patients with high nutritional risk (NRS2002 score ≥ 5) may profit from preoperative nutritional support manifested in the reduction of CR-POPF
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