Nutritional Status Affects the Rate of Pancreatic Fistula after Distal Pancreatectomy: A Multivariate Analysis of 132 Patients

• Published in: Journal of the American College of Surgeons Vol. 205; no. 1; pp. 52 - 59
• Main Authors: Sierzega, Marek, MD, PhD, Niekowal, Bogdan, MD, Kulig, Jan, MD, PhD, Popiela, Tadeusz, MD, PhD, FACS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2007; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Databases, Factual; Female; General aspects; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Malnutrition - complications; Medical sciences; Middle Aged; Multivariate Analysis; Nutrition Assessment; Nutritional Status; Pancreatectomy - adverse effects; Pancreatic Fistula - etiology; Retrospective Studies; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; distal pancreatectomy; Instant Nutritional Assessment; NRI; DP; INA; Nutritional Risk Index; Human; Medicine; Treatment; Surgery; Distal; Rate; Pancreatectomy; Patient; Fistula; Multivariate analysis; Pancreas; Nutritional status
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2007.02.077

Background Although malnutrition was found to increase the risk of intraabdominal and systemic complications in surgical patients, data for distal pancreatic resections are scarce. Study Design Data on 132 consecutive patients undergoing distal pancreatectomy as the primary procedure for pancreatic pathology, between 1996 and 2005, were reviewed to identify risk factors for postoperative complications and determine the impact of nutritional status. Nutritional assessment was performed with clinical and laboratory variables, including unintentional weight loss, body mass index, blood albumin level, lymphocyte count, and Nutritional Risk Index (NRI) and Instant Nutritional Assessment (INA) scores. Results Seventy-five (56.8%) patients developed 1 or more complications, including 18 (13.6%) cases of pancreatic fistula. The median values of NRI were significantly lower in patients with pancreatic fistula (96.9; 95% CI, 89.8 to 101.0) compared with those in the remaining subjects (102.5; 95% CI, 101.5 to 105.5; p = 0.014). In the univariate analysis, the incidence of malnutrition defined by NRI (61% versus 30%, p = 0.019) and the Instant Nutritional Assessment (67% versus 34%, p = 0.017) was significantly higher in patients who developed pancreatic fistula. In the multivariate analysis, malnutrition characterized as NRI of 100 or less was the only factor that significantly increased the risk of pancreatic fistula, with an odds ratio of 8.12 (95% CI, 1.06 to 22.30). Conclusions Malnutrition, as defined by composite nutritional assessment scales consisting of clinical and laboratory parameters, is a major risk factor for pancreatic fistula after distal pancreatectomy.