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Back to 2015 Annual Meeting Program Preoperative Nutritional Assessment in Patients Undergoing Whipple Pancreatoduodenectomy and Its Relationship to Early Outcome Dhaivat K. Vaishnav*1, 2, Hariharan Ramesh3 1surgical gastroenterology, swasti gastroenterology center, Ahmedabad, India; 2Ex fellow at surgical gastroenterology, lakesore hospital and research center, Kochi, India; 3surgical gastroenterology and liver transplantation, lakeshore Hospital, Kochi, India
Objectives: To determine the incidence of preoperative malnutrition among patients scheduled to undergo pancreatoduodenectomy and to evaluate the effect of preoperative nutritional status on early postoperative outcome.Material and methods:This study was conducted between July 2011 and December 2012 at the Surgical Gastroenterology department at a tertiary centre. Patients posted for Whipple pancreatoduodenectomy for various etiologies were included. Nutritional assessment (Subjective Global Assessment (SGA), body mass index (BMI; normal >18 kg/m2 or less than 25),Mid Arm Muscle Circumference (MAMC; normal > 27 mm), Triceps skin fold thickness (TSFT; normal >9 mm)), serum albumin (normal >3.0 g/dl) and Prognostic Nutritional Index (normal >40)was done for 83 patients scheduled for pancreatoduodenectomy on the day prior to surgery.Resectionwas done in 73 patients and these patients were analyzed for post operative outcome.Results -Median age of study group was 56 years. Fifty one were male and 32 female. Median value of BMI was 23.2 Kg/ m2 (range 13.54-32.90).Median value of PNI was 47 (range 27.5-65.5).Malnutrition was identified in 59 (SGA grade B-48, SGA grade C-11) out of 83 patients. With other modalities rate of detection of malnutrition was less (BMI - 21/83, PNI-11/83, MAMC-7/83 andTSFT-11/83). Five out of 11 SGA grade C patients were found to have unresectable/metastatic disease at exploration whereas PNI < 40 only picked up 3 advanced disease. Univariate analysis failed to show significant correlation between SGA predicted under nutrition and post operative complications like pancreatic fistula (p= 0.639), post pancreatectomy hemorrhage (p= 0.120), abdominal collections (P=0.399). Poor SGA grade had statistically significant correlation with post operative delayed gastric emptying (p= 0.001). For over all complication rate correlation was not significant, but trend towards Poor SGA score resulted in higher frequency of complications (p = 0.094). BMI >25 was significantly associated with pancreatic fistula (0.009),abdominal collections (p=0.005) as well as readmission rates (p=0.039). Multivariate analysis had also shown high BMI as independent predictive factor for pancreatic fistula (p= 0.04). However, correlation was not significant between BMI and over all complication rate (p=0.161). Conclusions: Multiple risk factors associated in pancreatic surgery that results in pancreatic fistula, malnutrition is a modifiable risk factor, and it should be addressed. Subjective Global Assessment appears to be superiorin identifying patients with a nutritional risk at early stage as compare to other assessment tools.Early enteral feeding may account for the fact that patients with malnutrition did not have a higher frequency of overall post operative complications in this study.
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