Citation
Katz M, Wollin DA, Donin NM, Meeks W, Gulig S, Zhao LC, Wysock JS, Taneja SS, Huang WC, Bjurlin MA. Effect of Malnutrition on Radical Nephroureterectomy Morbidity and Mortality: Opportunity for Preoperative Optimization. Clin Genitourin Cancer. 2018 Aug;16(4):e807-e815.
Abstract
Nutritional status has been increasingly recognized as an important predictor of prognosis and surgical outcomes for cancer patients. We evaluated the effect of preoperative malnutrition on the development of surgical complications and mortality after radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Using data from the American College of Surgeons National Surgical Quality Improvement Program, we evaluated the association of poor nutritional status with 30-day postoperative complications and overall mortality after RNU from 2005 to 2015. The preoperative variables suggestive of poor nutritional status included hypoalbuminemia (< 3.5 g/dL), weight loss within 6 months before surgery (> 10%), and a low body mass index. A total of 1200 patients were identified who had undergone RNU for UTUC. The overall complication rate was 20.5% (n = 246), and mortality rate was 1.75% (n = 21). On univariate analysis, patients who experienced a postoperative complication were more likely to have hypoalbuminemia (25.0% vs. 11.4%; P < .001) and weight loss (3.7% vs. 1.0%; P = .003). After controlling for baseline characteristics and comorbidities, hypoalbuminemia was found to be a significant independent predictor of postoperative complications (odds ratio, 2.09; 95% confidence interval, 1.29-3.38; P = .003). Hypoalbuminemia was also a significant independent predictor of mortality (odds ratio, 4.31; 95% confidence interval, 1.45-12.79; P = .008) on multivariable regression analysis. Our results have shown that hypoalbuminemia is a significant predictor of surgical complications and mortality after RNU for UTUC. This finding supports the importance of patients' preoperative nutritional status in this population and suggests that effective nutritional interventions in the preoperative setting could improve patient outcomes.
Key Points
- Published in Clinical genitourinary cancer in 2018.
- Indexed in PubMed as PMID 29550201.
- Mapped to Ureteral Reconstruction, Uro-Oncology, Outcomes, Methods & Education.
- Abstract available from PubMed and rendered as static text on this page.
Clinical Relevance
This work sits within Dr. Zhao's upper urinary tract reconstruction bibliography, including robotic ureteral repair, buccal mucosa graft ureteroplasty, reimplantation, pyeloplasty failure, and complex salvage reconstruction.