S1329 The Clinical Impact of Malnutrition on the Postoperative Outcomes of Patients With Gastric Cancer Undergoing Gastrectomy

Abstract

INTRODUCTION: Gastrectomy is the standard of care surgical approach in patients with non-metastatic gastric cancer. However, gastric cancer can cause reduced gastric activity and gastric obstruction, which results in malnutrition and weight loss. In this study, we evaluate the effects of malnutrition on the postoperative outcomes of patients with gastric cancer undergoing gastrectomy. METHODS: Gastric cancer patients with partial or complete gastrectomy were selected from the 2011-2017 National Inpatient Sample and were stratified by malnutrition (a composite variable comprised of protein-calorie malnutrition, sarcopenia, and pathologic weight loss). The endpoints included mortality, length of stay (LOS), hospitalization costs, and postoperative complications. A subgroup analysis of partial versus complete gastrectomy was performed on the malnutrition cohort. RESULTS: Of the 4800 patients with gastric cancer who underwent gastrectomy, 947 had malnutrition. The malnutrition cohort was older (67.3 vs 65.6y P < 0.01) but had a similar gender distribution (female 44.9 vs 44.6% P = 0.92). Mortality was higher in the malnutrition cohort (6.97 vs 2.57% P < 0.01, OR 2.84 95%CI 2.06-3.91), as were the LOS (17.3 vs 10.2d P < 0.01) and hospitalization costs ($201,429 vs $114,264 P < 0.01). The malnutrition cohort had higher rates of bleeding complications (3.70 vs 2.15% P < 0.01, OR 1.74 95%CI 1.17-2.60), bowel perforation (1.16 vs 0.42% P = 0.01, OR 2.82 95%CI 1.30-6.09), bowel obstruction (12.5 vs 5.71% P < 0.01, OR 2.35 95%CI 1.86-2.98), wound complication (3.59 vs 1.09% P < 0.01, OR 3.38 95%CI 2.14-5.34), and postoperative infections (6.23 vs 3.04% P < 0.01, OR 2.12 95%CI 1.54-2.93). In a multivariate analysis, the malnutrition was associated with mortality (P < 0.01, aOR 1.77 95%CI 1.23-2.53). Subgroup analysis comparing partial (n = 617) to complete (n = 330) gastrectomy showed that the two cohorts had similar mortality (6.06 vs 7.46% P = 0.5), LOS (17.3 vs 17.2d P = 0.5), hospitalization costs ($214,084 vs $194,660 P = 0.01), and postoperative complications (bleeding 4.55 vs 3.24 P = 0.41; bowel perforation 0.91 vs 1.30 P = 0.76; bowel obstruction 15.2 vs 11.0 P = 0.08; wound complication 3.64 vs 3.57 P = 1; infections 6.67 vs 6% P = 0.79). CONCLUSION: Malnutrition is associated with mortality and postoperative complications in patients with gastric cancer undergoing gastrectomy. These patients therefore require preoperative risk-assessment and goal-directed nutritional therapy, followed by surveillance of post-gastrectomy complications.Figure 1.: Multivariate model: malnutrition is associated with increased postoperative mortality in patients with gastric cancer undergoing gastrectomy.