48 - Preissitzung
Felix Largiadèr Preissitzung
16. Mai 2019, 10:15 - 11:45, Bellavista 3+4, 6. OG
Prospective trial to evaluate the prognostic value of different nutritional assessment scores in liver surgery
P. Probst1, J. Fuchs1, M. R. Schoen2, G. Polychronidis1, C. Stravodimos2, A. Mehrabi1, M. K. Diener1, P. Knebel1, K. Hoffmann1, Presenter: P. Probst1 (1Heidelberg/DE, 2Karlsruhe/DE)
Malnutrition is recognized as a preoperative risk factor for patients undergoing hepatic resection. To take preventive therapeutic actions before surgery, it is important to identify malnourished patients. However, there is no evidence, which existing nutritional assessment score (NAS) is suited best to predict the postoperative outcome in liver surgery.
All patients scheduled for elective liver resection were screened for eligibility. Before surgery, every patient was assessed to be at risk for malnutrition or not according to Nutritional Risk Index, Nutritional Risk Screening original and 2002, Subjective Global Assessment, Malnutrition Universal Screening Tool, Mini Nutritional Assessment original and SF, Short Nutritional Assessment Questionnaire, Imperial Nutritional Screening System I+II, Nutritional Risk Classification and the ESPEN malnutrition criteria. Throughout the patient’s hospital stay, postoperative morbidity and mortality was tracked prospectively. The association of malnutrition according to each score and occurrence of at least one major complication was the primary endpoint, using a multivariable logistic regression analysis including established risk factors in liver surgery as covariates.
The population consisted of 182 patients. The percentage of patients labelled as malnourished by the NAS varied among the different scores, with the lowest being at 2.2% (Mini Nutritional Assessment) and the highest at 52.2% (Nutritional Risk Classification). In 40 patients (22.0%) a major complication was observed. None of the scores showed a significant association with the occurrence of major complications in the multivariable analysis.
None of the twelve NAS investigated defined a state of malnutrition which was independently associated with postoperative complications. A delay of surgery by a diagnosed malnutrition based on these NAS are not justified. Other measures to determine malnutrition in liver surgery should be investigated prospectively.