Assessing the Effect of Preoperative Nutrition on Upper Body Function in Elderly Patients Undergoing Elective Abdominal Surgery

Definition and assessment of frailty in older patients: the surgical, anaesthesiological and oncological perspective

The number of oncology, surgery and anaesthesia procedures in older patients has greatly increased in recent years due to ageing populations. Older patients are typically characterised by physical changes such as comorbidities, decline in physiological activities and cognitive impairment. All these factors, together with polypharmacological therapies, may substantially impact perioperative outcome, quality of recovery and, more in general, quality of life. A comprehensive multidisciplinary approach to perioperative care is thus needed. The assessment of frailty has a central role in the pre-operative evaluation of older patients and, with a multidisciplinary approach. The best surgical procedures and oncologic therapies can be accurately discussed in the pre- and post-operative periods. All clinicians involved in this scenario should be proactive in multidisciplinary care to achieve better outcomes.

Effects of Preoperative Malnutrition on Postoperative Surgical Outcomes and Quality of Life of Elderly Patients with Periampullary Neoplasms: A Single-Center Prospective Cohort Study

Background/Aims

We investigated the effect of preoperative malnutrition on postoperative surgical outcomes in elderly patients undergoing pancreatoduodenectomy for periampullary neoplasms.

Methods

This prospective cohort study enrolled 154 patients aged ≥65 years with periampullary neoplasms. Using the Mini Nutritional Assessment tool, patients were categorized into three groups according to their preoperative nutritional status: well-nourished (13.0%), at-risk-of-malnutrition (59.7%), and malnourished (27.3%).

Results

Significant intergroup differences were observed in preoperative body mass index (25.6±2.4 kg/m² [well-nourished] vs 23.4±2.6 kg/m² [at-risk-of-malnutrition] vs 21.1±2.8 kg/m² [malnourished], p<0.001). The overall morbidity significantly differed between the well-nourished and malnourished groups (20% vs 50.0%, p=0.024). The rates of clinically significant postoperative pancreatic fistula were significantly different among groups (p=0.035). Univariate and multivariate analyses showed that the at-risk-of-malnutrition or malnourished status (hazard ratio [HR], 3.45; p=0.037) and intraoperative blood loss (HR, 1.01; p=0.040) significantly affected the overall postoperative morbidity in elderly patients.

Conclusions

Before surgery, 87.0% of patients were classified into the at-risk-of-malnutrition or malnourished group. Compared with well-nourished patients, patients with nutritional issues showed a higher overall surgical morbidity. Improved preoperative nutritional status leads to favorable surgical outcomes in elderly patients.