Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool

The impact of preoperative single low-dose dexamethasone on in-hospital prognosis in geriatric intertrochanteric fracture patients: Analysis of secondary outcomes in a randomized controlled trial

BACKGROUND

Intertrochanteric fracture in the geriatric population is associated with poor prognosis, which may be attributed to consistent stress and the systemic inflammatory response. Dexamethasone is an exogenous glucocorticoid commonly used in clinical practice for broad anti-inflammatory action. The purpose is to investigate whether a single preoperative low-dose dexamethasone can improve the in-hospital prognosis in geriatric intertrochanteric fracture patients undergoing internal fixation surgery.

METHODS

Between June 2020 and October 2022, 219 eligible patients with intertrochanteric fractures were in this study. After meeting the inclusion and exclusion criteria, 160 patients were randomly allocated to the dexamethasone or placebo groups (80 patients who are geriatric with an intertrochanteric fracture in each group). The patients in the dexamethasone group received 10 mg (2 mL) of dexamethasone intravenously, whereas the patients in the placebo group received 2 mL of saline intravenously within 30 minutes before being sent to the operating room. The efficacy-related outcomes (the first bed-chair transfer ability, in-hospital mortality, and length of stay) and safety-related outcomes (infection events and hyperglycemia) were collected for analysis.

RESULTS

There were no significant differences in the baseline characteristics between the 2 groups. The dexamethasone group had a significantly higher rate of the first bed-chair transfer than the placebo group (65.0% [52/80] vs 48.8% [39/80], relative risk = 1.46, 95% confidence interval = 1.02 to 2.11; P = .038). One patient in the dexamethasone group and 7 patients in the placebo group died during hospitalization (1.3% [1/80] vs 8.8% [7/80], relative risk = 0.92, 95% confidence interval = 0.86 to 0.99; P = .07). No differences were found in the length of stay, infections, and hyperglycemia between the 2 groups.

CONCLUSION

A single preoperative low-dose of dexamethasone can improve the in-hospital prognosis (increase the ability of the first bed-chair transfer and potentially decrease the in-hospital mortality) in geriatric intertrochanteric fracture patients after internal fixation surgery.

A single preoperative low-dose dexamethasone may reduce the incidence and severity of postoperative delirium in the geriatric intertrochanteric fracture patients with internal fixation surgery: an exploratory analysis of a randomized, placebo-controlled trial

OBJECTIVE

Postoperative delirium (POD) is a common complication along with poor prognosis in geriatric intertrochanteric fracture (ITF) patients. However, the prevention and treatment of POD remain unclear. Previous studies have confirmed that POD is essentially a consequence of neuro-inflammatory responses. Dexamethasone is a glucocorticoid with comprehensive anti-inflammatory effects, while a high dose of dexamethasone correlates with many side effects or even adverse consequences. Thus, this prospective study aims to discuss whether a single preoperative low-dose dexamethasone can reduce the impact of POD on geriatric ITF patients with internal fixation surgery.

METHODS

Between June 2020 and October 2022, there were 219 consecutive ITF patients assessed in our department. Of the 219 ITF patients, 160 cases who met the inclusion and exclusion criteria were finally enrolled and randomly allocated to the dexamethasone group and the placebo group (80 geriatric ITF patients in each group) in this prospective study. The patients in the dexamethasone group received intravenous 10 mg (2 ml) dexamethasone while the patients in the placebo group received intravenous 2 ml saline in 30 min before being sent to the operating room, respectively. The baseline characteristics, surgical information, incidence and severity of POD as the efficacy-related outcomes, and infection events and hyperglycemia as safety-related outcomes (adverse events), were collected and analyzed between the two groups. The severity of POD was evaluated by Memorial Delirium Assessment Scale (MDAS) score.

RESULTS

There were no differences in baseline characteristics and surgical information between the dexamethasone group and the placebo group. The dexamethasone group had a lower incidence of POD than the placebo group within the first 5 days after surgery [(9/80, 11.3% vs. 21/80, 26.3%, RR = 0.83, 95% CI 0.71-0.97, P = 0.015]. The dexamethasone group had lower MDAS scores (Mean ± SD) than the placebo group [13.2 ± 1.0 (range 11 to 15) vs. 15.48 ± 2.9 (range 9 to 20), P = 0.011, effect size = 0.514]. There were no differences in infection events and hyperglycemia between the two groups.

CONCLUSIONS

A single preoperative low-dose dexamethasone may reduce the incidence and severity of POD in geriatric ITF patients with internal fixation surgery.

TRIAL REGISTRATION

ChiCTR2200055281.

Preoperative Nutritional Optimization of the Oncology Patient: A Scoping Review

BACKGROUND

Malnutrition is common among patients with cancer and is a known risk factor for poor postoperative outcomes; however, preoperative nutritional optimization guidelines are lacking in this high-risk population. The objective of this study was to review the evidence regarding preoperative nutritional optimization of patients undergoing general surgical operations for the treatment of cancer.

METHODS

A literature search was performed across the Ovid (MEDLINE), Cochrane Library (Wiley), Embase (Elsevier), CINAHL (EBSCOhost), and Web of Science (Clarivate) databases. Eligible studies included randomized clinical trials, observational studies, reviews, and meta-analyses published between 2010 and 2020. Included studies evaluated clinical outcomes after preoperative nutritional interventions among adult patients undergoing surgery for gastrointestinal cancer. Data extraction was performed using a template developed and tested by the study team.

RESULTS

A total of 5,505 publications were identified, of which 69 studies were included for data synthesis after screening and full text review. These studies evaluated preoperative nutritional counseling, protein-calorie supplementation, immunonutrition supplementation, and probiotic or symbiotic supplementation.

CONCLUSIONS

Preoperative nutritional counseling and immunonutrition supplementation should be considered for patients undergoing surgical treatment of gastrointestinal malignancy. For malnourished patients, protein-calorie supplementation should be considered, and for patients undergoing colorectal cancer surgery, probiotics or symbiotic supplementation should be considered.

Malnutrition in elective shoulder arthroplasty: a multi-institutional retrospective study of preoperative albumin and adverse outcomes

BACKGROUND

Malnutrition is associated with poor postoperative outcomes after knee, hip, and spine surgery. However, whether albumin labs should be part of the routine preoperative workup for shoulder arthroplasty remains understudied. This study investigated the role of preoperative albumin levels in predicting common postoperative adverse outcomes in patients undergoing shoulder arthroplasty.

METHODS

All shoulder arthroplasty cases performed at 2 tertiary referral centers between July 2013 and May 2019 (institution 1) and between June 2007 and Feb 2020 (institution 2) were reviewed. A total of 421 primary and 71 revision elective shoulder arthroplasty cases had preoperative albumin levels recorded. Common demographic variables and relevant Elixhauser comorbidities were pulled. Outcomes gathered included extended (>3 days) postoperative inpatient length of stay (eLOS), 90-day readmission, and discharge to rehab or skilled nursing facility (SNF).

RESULTS

The prevalence of malnutrition (albumin <3.5 g/dL) was higher in the revision group compared with the primary group (36.6% vs. 19.5%, P = .001). Reverse shoulder arthroplasty (P = .013) and increasing American Society of Anesthesiologists score (P = .016) were identified as independent risk factors for malnutrition in the primary group. In the revision group, liver disease was associated with malnutrition (P = .046). Malnourished primary shoulder arthroplasty patients had an increased incidence of eLOS (26.8% vs. 13.6%, P = .003) and discharge to rehab/SNF (18.3% vs. 10.3%, P = .045). On univariable analysis, low albumin had an odds ratio (OR) of 2.34 for eLOS (P = .004), which retained significance in a multivariable model including age, American Society of Anesthesiologists score, sex, and body mass index (OR 2.11, P = .03). On univariable analysis, low albumin had an OR of 1.94 for discharge to SNF/rehab (P = .048), but this did not reach significance in the multivariable model. Among revisions, malnourished patients had an increased incidence of eLOS (30.8% vs. 6.7%, P = .014) and discharge to rehab/SNF (26.9% vs. 4.4%, P = .010). In both the primary and revision groups, there was no difference in 90-day readmission rate between patients with low or normal albumin.

CONCLUSION

Malnutrition is more prevalent among revision shoulder arthroplasty patients compared with those undergoing a primary procedure. Primary shoulder arthroplasty patients with low preoperative albumin levels have an increased risk of eLOS and may have an increased need for postacute care. Low albumin was not associated with a risk of 90-day readmissions. Albumin level merits further investigation in large, prospective cohorts to clearly define its role in preoperative risk stratification.

Cognitive impairment assessment and interventions to optimize surgical patient outcomes

For elderly patients undergoing elective surgical procedures, preoperative evaluation of cognition is often overlooked. Patients may experience postoperative delirium (POD) and postoperative cognitive decline (POCD), especially those with certain risk factors, including advanced age. Preoperative cognitive impairment is a leading risk factor for both POD and POCD, and studies have noted that identifying these deficiencies is critical during the preoperative period so that appropriate preventive strategies can be implemented. Comprehensive geriatric assessment is a useful approach which evaluates a patient's medical, psycho-social, and functional domains objectively. Various screening tools are available for preoperatively identifying patients with cognitive impairment. The Enhanced Recovery After Surgery (ERAS) protocols have been discussed in the context of prehabilitation as an effort to optimize a patient's physical status prior to surgery and decrease the risk of POD and POCD. Evidence-based protocols are warranted to standardize care in efforts to effectively meet the needs of these patients.

Inflammatory markers as predictors of postoperative adverse outcome in octogenarian surgical patients: an observational prospective study

INTRODUCTION

The value of inflammatory proteins, interleukin-6 and alpha-1-acid glycoprotein as prognostic factors in elderly people undergoing surgery has not been determined yet.

OBJECTIVE

To know whether preoperatively determined inflammatory markers may predict the postoperative outcome of elderly patients undergoing surgery. A scoring system for predicting postoperative morbidity was assessed.

METHODS

Hospital-based observational prospective study, with geriatric surgical patients. Preoperative determination of following data: age, gender, scheduled or urgent operation, comorbid diseases, malignancy, physical, mental and nutritional profile. Biochemical markers of inflammation, C Reactive Protein, interleukin-6, and alpha-1-acid glycoprotein were also studied. Preoperative data and postoperative complications were recorded. Binary logistic regression analysis was used to obtain a morbidity risk prediction model.

RESULTS

A total of 225 patients were included. Fifty-five patients (24.4%) had postoperative complications, with a mortality rate of 5.3%. Binary logistic regression analysis showed an independent relation between morbidity and the variables malignancy, alpha-1-acid glycoprotein and interleukin-6. The risk (R) of postoperative morbidity adjusted by age was calculated. The model showed a 22.2% sensitivity, 94.8% specificity, and a percentage of correct classification of 78.3%. The area under the ROC curve was 0.781 (95% CI: 0.703-0.858).

CONCLUSIONS

An age-adjusted equation for predicting 30-day morbidity that included malignancy, serum IL-6 and alpha 1-acid glycoprotein levels may be useful for risk assessment in octogenarian surgical patients.

Assessment of dietary intake and nutritional status (MNA) in Polish free-living elderly people from rural environments

The proportion of elderly people in the global population is rapidly increasing. Their nutritional status indicates many deficiencies that are risky to health. The aim of this paper was to assess the nutrition and nutritional status in elderly individuals above 60 years old living in their family houses in rural areas. Dietary intake and nutritional status were measured in 174 elderly women and 64 men living in the rural areas of Oleśnica (near Wrocław, SW Poland). Energy intake, consumption of nutrients, selected anthropometric and biochemical indicators, were measured in two groups: one at risk of malnutrition and one with adequate nutrition. Using the mini nutritional assessment (MNA) questionnaire, 238 persons over 60 years of age were qualified according to their nutritional status. Anthropometric and biochemical parameters were measured. The group of women at risk of malnutrition (n=30) showed a statistically significantly lower energy intake in their diet (1,127 kcal) compared to women with adequate nutrition (1,351 kcal). The entire group of examined individuals showed a too low consumption of fiber, calcium, vitamins C and D, and folates. Most of the examined women had a too high body mass index (BMI) (on average 28.8), waist circumference was 96.3 cm, and the triceps skinfold (TSF) was 25.2mm thick. Women at a risk of malnutrition had statistically significantly lower lipid parameters than those with adequate nutrition (respectively: TC 191.1 vs. 219.1m/dl, p<0.001, LDL-cholesterol 107.1 vs. 125.1m/dl, p<0.008, TG 129 vs. 143 mg/dl). Men with a risk of malnutrition had a statistically significantly lower BMI (26.0 vs. 28.7, p<0.04), and also lower waist and arm perimeters compared to men with correct nutrition. According to the Charlson comorbidity index (CCI), 8.2% of person with adequate nutrition had poor prognostic indicator for overall survival. All the examined individuals showed many significant nutritional deficiencies. The group with nutritional risk had more pronounced nutritional deficiencies. Despite a too low energy value of foods among individuals with correct nutrition, their anthropometric parameters paradoxically showed the presence of excessive fatty tissue. The most frequent diseases existed in examined group were coronary artery disease and congestive heart failure.

Evaluation of the Mini Nutritional Assessment in the elderly, Tehran, Iran

OBJECTIVE

To determine whether the Mini Nutritional Assessment (MNA) can screen and diagnose for malnutrition in the Iranian elderly.

DESIGN

The MNA was administered to all volunteers. Each patient underwent anthropometric and serum albumin measurements. Reliability, validity, sensitivity, specificity, positive- and negative-predictive values were estimated. To identify optimal threshold values for predicting malnutrition, receiver-operating characteristic curve analysis was performed for MNA scores.

SETTING

Kahrizak Charity Foundation (Tehran, Iran).

SUBJECTS

Two hundred and twenty-one consecutive elderly patients entered into the cross-sectional study. Amputees and patients with liver or renal disorders, oedema or any end-stage diseases were excluded.

RESULTS

According to MNA score, 3.2 % were malnourished, 43.4 % were at risk of malnutrition and 53.4 % were well nourished. The proportions in these categories according to ideal body weight and serum albumin were 2.3 %, 17.1 % and 80.6 %, respectively. Cronbach's alpha coefficient (reliability) was 0.61. The correlations between total MNA score, anthropometric values and serum albumin (criterion-related validity) were all significant. There were significant differences in total MNA score between two BMI groups but not between two categories according to serum albumin and skin ulcers (construct validity). The sensitivity and specificity of the MNA according to its established cut-off points were 82 % and 63 %, respectively. Positive-predictive value was 35 % and negative-predictive value was 93 %. By using the best cut-off point (MNA score of 22 according to Youden index), the sensitivity, specificity, positive-predictive value and negative-predictive value were 88 %, 62 %, 57 % and 89 %, respectively.

CONCLUSIONS

The MNA with its established cut-off points may not be a good fit for Asian populations, including Iranian elderly.

Surgery in older people: an update

In the past two decades, the rate of surgery in older people has increased more rapidly than the rate of aging of the population, so both a larger proportion and a greater number of older people are now undergoing surgery. This may partly reflect a cultural change in surgery and anaesthesia with respect to a greater willingness to undertake elective procedures in older people, although there remain areas where they have less access to surgery than do younger patients. For instance, older people are less likely to undergo operative procedures after a cancer diagnosis. Furthermore, in those who do have surgery, resection rate (i.e. curative therapy) is lower than in younger people with equivalent tumour stages, and even more so in older patients with COPD, cardiovascular disease or diabetes. This article explores the complex relationship between age and surgical outcome, provides an evidence-based overview of risk assessment and common postoperative problems in older people, and summarizes good practice points (at times necessarily pragmatic) for clinical management of the older surgical patient. There has been a substantial expansion in the literature examining risks, outcomes and interventions in older surgical patients since the previous review article of this subject published in this journal. Although we do not cover anaesthesia in older people, the review of that topic remains relevant. The American Society of Anaesthesiologists' Classification of Risk which illustrates that risk is disease- rather than age- based, is shown in Table 1. Most publications examine elective rather than emergency surgery in older people (with the exception of hip fracture), and this is reflected in the content of the paper.

Nutritional screening and assessment tools for older adults: literature review

AIM

This paper reports a literature review to examine the range of published tools available for use by nurses to screen or assess nutritional status of older adults, and the extent to which validity, reliability, sensitivity, specificity and acceptability of the tools has been addressed.

BACKGROUND

The incidence of malnutrition in older adults is high. One method by which malnutrition or risk of malnutrition can be detected is by the use of nutritional screening or assessment tools.

METHODS

A comprehensive literature review methodology was employed. A variety of electronic databases were searched for the period 1982-2002. Search terms incorporating nutrition, screening, validity, reliability and sensitivity and specificity were combined to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. In this paper, nutritional screening or assessment tools are described as tools which use a questionnaire-type format containing more than one risk factor for malnutrition, and give a quantitative or categorical assessment of risk.

RESULTS

Seventy-one nutritional tools were located, 21 of which were identified as designated for use with an older population. A wide variety of risk factors for malnutrition are used with the tools, ranging from objective measurements to subjective assessment. Some tools identify an action plan based on the score obtained. Many tools appear not to have been subjected to validity and/or reliability testing but are used clinically.

CONCLUSIONS

As malnutrition is present in the older adult population, nutritional assessment and screening tools can be useful to highlight those in need of a nutritional care plan. However, many have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity in clinical use. The decision to use a particular tool should therefore be considered carefully.

No correlation between mini-nutritional assessment (short form) scale and clinical outcomes in 73 elderly patients admitted for hip fracture

BACKGROUND AND AIMS

Malnutrition in general and protein deficiency in particular, both upon admission and during the recovery period, may adversely influence the clinical outcome after hip fracture. This study investigates the relationship between nutritional status measured by the Mini-Nutritional Assessment short form (MNA-SF) and biological markers in elderly hip-fractured patients.

METHODS

A prospective study in a university hospital. The MNA-SF nutritional scale and laboratory values (serum albumin, cholesterol, total lymphocyte count) were assessed within three days after hip fracture surgery.

RESULTS

Seventy-three patients were included: 61 (84%) were women and 12 men. Mean age was 81.5+/-7.1 years. Inhospital mortality was 10%. The mean MNA-SF score was 11+/-0.5 (range 3-14); according to these values, 39 patients (53%) were at risk of malnutrition. MNA-SF scores were not significantly correlated to patients' laboratory values. Fourteen episodes of nosocomial infection were diagnosed in 11 patients, and 6 patients developed pressure ulcers during hospitalization.

CONCLUSIONS

MNA-SF test scale values reflect a clinical process in post-operative hip-fractured patients which is different from serum albumin, cholesterol or lymphocyte count.

The nutritional status of older men with advanced prostate cancer and factors affecting it

AIM

Our aim was to study the nutritional status of older men receiving treatment for advanced prostate cancer (PC).

METHOD

We assessed 80 patients: 40 patients with advanced PC (research group) and 40 with benign prostatic hyperplasia (BPH) (control group). The instruments used were: Mini Nutritional Assessment (MNA) and the Yesavage Geriatric Depression Scale (GDS)-Short Form. Complementary questions were asked reflecting nutritional status.

RESULTS

Mean age of PC patients was 72 (65-94) years and that of control group 71 (65-85) years. Patients with PC had rapid weight loss--15 (39.5%) of patients lost more than 3 kg over 3 months. Depressive symptomatology was more common in the research group (p<0.05), and it was inversely correlated with nutrition. Age had no influence on symptoms of depression. Digestive disorders troubled 23 (57.5%) of the research group and 14 (20%) of the control group. Digestive troubles had an influence on appetite in both groups t=0.54 and r=0.46 (p<0.05). No patient who had digestive symptoms was instructed as to how to control them.

CONCLUSIONS

Among PC patients, 50% were at risk of malnutrition compared to 7.5% in the BPH group, as assessed by the MNA questionnaire. Patients suffering from PC were more depressed than those with BPH. A higher degree of depressive symptomatology was related to poorer nutritional status. Assessment of nutritional status is important and should be routinely performed in older men with PC.

Safe major abdominal operations: Hepatectomy, gastrectomy and pancreatoduodenectomy in elder patients

AIM: To evaluate the impact of advanced age on outcome after hepatectomy, gastrectomy and pancreatoduodenectomy.

METHODS: Two hundreds and eleven patients undergone hepatectomy, gastrectomy and pancreatoduodenectomy from January 1998 to September 2002 were analyzed retrospectively. Clinicopathologic features and operative outcome of 83 patients aged 65 years or more were compared with that in 128 younger patients aged less than 65 years.

RESULTS: The nutritional state, such as pre-operation level of serum albumin and hemoglobin in the older patients was poorer than that in the younger patients. The older patients had higher comorbidities than the younger patients (48.2% vs 15.6%). No significant difference was observed in perioperative mortality, and complication rate between the older and younger patients (2.4% vs 1.6% and 22.9% vs 20.3%, respectively). Multivariate analysis demonstrated that pancreatoduodenectomy, hepatectomy with resection of more than 2 segments and comorbidities were independent predictors of postoperative complication, whereas age was not (P = 0.3172).

CONCLUSION: It is safe for patients aged 65 years or more to undergo hepatic, pancreatic and gastric resection if great care is taken during perioperative period.

Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment

In more than 10,000 elderly persons, the mean prevalence of malnutrition is 1% in community-healthy elderly persons, 4% in outpatients receiving home care, 5% in patients with Alzheimer's disease living at home, 20% in hospitalized patients, and 37% in institutionalized elderly persons. In community-dwelling elderly persons, the MNA detects risk of malnutrition and life-style characteristics associated with nutritional risk while albumin levels and the BMI are still in the normal range. In outpatients and in hospitalized patients, the MNA is predictive of outcome and cost of care. In home care patients and nursing home residents, the MNA is related to living conditions, meal patterns, and chronic medical conditions and allows targeted intervention. The MNA has been used successfully in follow-up evaluation of outcome, nutritional intervention, nutritional education programs, and physical intervention programs in elderly persons. The MNA-SF allows quick screening to determine a person's risk of malnutrition. Early detection of malnutrition is important to allow targeted nutritional intervention and should be a key component of the geriatric assessment. The MNA test is a simple, noninvasive, well-validated screening tool for malnutrition in elderly persons and is recommended for early detection of risk of malnutrition. The MNA, as a two-step procedure (screening with the MNA-SF followed by assessment, if needed, by the full MNA), is reliable and can be easily administered by general practitioners and by health professionals at hospital or nursing home admission for early detection of risks of malnutrition. The MNA has the following characteristics: * The MNA is a two step procedure: (1) the MNA-SF to screen for malnutrition and risk of mainutrition; (2) assessment of nutritional status with the full MNA. * The MNA is an 18-item questionnaire comprising anthropometric measurements (BMI, mid-arm and calf circumference, and weight loss) combined with a questionnaire regarding dietary intake (number of meals consumed, food and fluid intake, and feeding autonomy), a global assessment (lifestyle, medication, mobility, presence of acute stress, and presence of dementia or depression), and a self-assessment (self-perception of health and nutrition). The MNA-SF comprises 6 items from the 18. * The MNA is well validated. It correlates highly with clinical assessment and objective indicators of nutritional status (albumin level, BMI, energy intake, and vitamin status). * A low MNA score can predict hospital-say outcomes in older patients and can be used to follow up changes in nutritional status. * Because of its validity in screening and assessing the risk of malnutrition, the MNA should be integrated in the comprehensive geriatric assessment. * In more than 10,000 elderly persons, the prevalence of undernutrition assessed by the MNA is 1% to 5% in community-dwelling elderly persons and outpatients, 20% in hospitalized older patients, and 37% in institutionalized elderly patients.

The Mini Nutritional Assessment-Short Form for preoperative nutritional evaluation of elderly patients

The Mini Nutritional Assessment (MNA) is a clinical tool designed for assessing nutritional status of elderly patients. Used in preoperative evaluation of ambulatory patients over 60 years of age seen on anesthesia consultation in a previous study, it identified 6.9% patients with overt malnutrition out of a group of 408. However, four-fifths of 291 ASA 1-2 patients were well nourished, and underwent needless, non-contributory and time-consuming test. The MNA-Short Form (MNA-SF) has recently been devised as the first step of a two-step process: if negative, there would be no need to complete "full" MNA. Therefore, the base data of 408 MNA forms completed during the above-mentioned study was used for the purpose of comparing the MNA-SF to the MNA, to test whether the MNA-SF could have been the first step of a two-step nutritional evaluation of anesthesia patients. Median (range) age, and BMI were 72 (60-98) years, and 25.2 (12.8-40.4) kg x m(-2), respectively. There were equal numbers of men and women. In 144 cases, the MNA-SF was found positive (35.3%) with a median MNA of 21.5 (1.5-27) points. The MNA-SF predicted absence of overt malnutrition revealed by the MNA, with 100% sensitivity and negative predictive value (NPV). It was found less efficient for predicting absence of "possible" nutritional problems detected by the MNA (sensitivity 85.6% and NPV 92.8%). However, none of the 19 borderline patients would have had overt malnutrition, being only found "at risk of malnutrition" by the MNA. On the studied sample, the MNA-SF would have correctly sorted out 69.5% of the patients without severe malnutrition. We believe the MNA-SF should be used as the first step of an efficient preoperative nutritional evaluation of ambulatory elderly patients.