SSAT - LOW PARENTERAL AMINO ACID DOSES RATHER THAN LOW PARENTERAL ENERGY WERE ASSOCIATED WITH WORSE CLINICAL OUTCOMES IN PATIENTS UNDERGOING GASTROINTESTINAL CANCER SURGERY: A COHORT STUDY USING REAL-WORLD DATA

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LOW PARENTERAL AMINO ACID DOSES RATHER THAN LOW PARENTERAL ENERGY WERE ASSOCIATED WITH WORSE CLINICAL OUTCOMES IN PATIENTS UNDERGOING GASTROINTESTINAL CANCER SURGERY: A COHORT STUDY USING REAL-WORLD DATA
Yoshikuni Kawaguchi^*¹, Kenta Murotani², Naoki Hayashi³, Satoru Kamoshita³
¹The University of Tokyo, Tokyo, Japan; ²Kurume University, Fukuoka, Japan; ³Otsuka Pharmaceutical Factory, Inc., Tokyo, Japan

Introduction
Nutritional management after gastrointestinal cancer surgery enhances recovery and improves clinical outcomes. However, the prescribed parenteral energy and amino acid doses do not always fulfill the doses of guideline recommendations. This raises concerns about nutritional deficiencies and their influence on clinical outcomes in patients after gastrointestinal cancer surgery. We hypothesized that patients who had higher parenteral energy or amino acid doses would be associated with better clinical outcomes. To address the hypothesis, we assessed the association of parenteral energy or amino acid doses with clinical outcomes in patients undergoing gastrointestinal cancer surgery using a large Japanese medical claims database.
Methods
Patients who underwent gastrointestinal cancer surgery between 2011 and 2022 and were fasting ? 7 days after surgery were identified in a Japanese medical claims database. The associations of parenteral energy/amino acid doses with clinical adverse events were investigated. Patients who were prescribed < 0.8 g/kg/day amino acid doses were defined as having low-amino acid and those who were prescribed ? 0.8 g/kg/day amino acid doses were defined as having high-amino acid according to the guideline recommendation. Patients who received low (< 0.8 g/kg/day) and high (? 0.8 g/kg/day) amino acid doses were compared using propensity score matching (PSM). The primary endpoint was clinical adverse events, and secondary endpoints were in-hospital mortality, postoperative complications, decline in activities of daily living, rehospitalization, hospital length of stay, and hospitalization cost.
Results
Patients who received low amino acid doses were significantly associated with a higher incidence of clinical adverse events (Figure 1A , P=0.002), but prescribed energy doses were not associated with clinical adverse events (Figure 1B, P=0.065). Of 18,294 eligible patients, 15,396 (84.2%) received low-amino acid doses (the low-amino acid group) and 2,898 (15.8%) received high-amino acid doses (the high-amino acid group). After PSM analysis, 2,585 pairs were formed. Clinical adverse events (42.1% vs. 45.1%, odds ratio [OR], 0.88; 95% confidence interval [CI], 0.79�0.99), in-hospital mortality (4.2% vs. 5.4%, OR, 0.77; 95% CI, 0.59�0.99), and hospitalization costs ($19,788 vs. $20,606, regression coefficient, -1,538; 95% CI, -2,250� -833) were significantly lower in the high-amino acid group than in the low-amino acid group.
Conclusion
Low parenteral amino acid doses rather than low parenteral energy were associated with worse clinical outcomes in patients undergoing gastrointestinal cancer surgery. Controlling parenteral amino acid doses may be a target to improve clinical outcomes in patients after gastrointestinal cancer surgery, particularly in those who are fasting for 7 days or longer.

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