Objectives Malnutrition increases risk of post-surgical morbidity in gynecologic malignancies. We assessed whether different malnutrition definitions are suitable for predicting morbidity in each cancer type.
Methods Patients undergoing resection of ovarian, uterine, or cervical cancer between 2005–2019 were identified using the NSQIP database. Body mass index (BMI), weight loss, and albumin were used to evaluate whether patients met various malnutrition criteria (severe, ESPEN1, ESPEN2, ACS, mild, albumin<3.5g/dL; figure 1). Outcomes included 30-day major post-operative complications, readmission, and reoperation. Modified Poisson regression was used to estimate the association between each definition and outcomes using risk ratios (RR) and 95% confidence intervals (CI).
Results Ovarian cancer patients meeting ESPEN2 had higher risk of readmission (RR 1.69;1.29–2.20), reoperation (RR 2.53;1.70–3.77), and complications (RR 1.36; 1.20–1.54; Table). Uterine cancer patients meeting ACS had increased risk of readmission (RR 2.74;2.09–3.59), reoperation (RR 3.61;2.29–5.71) and complications (RR 3.92;3.40–4.53). For cervical cancer, albumin<3.5 was associated with readmission (RR 1.48;1.01–2.19), reoperation (RR 2.25;1.17–4.34), and complications (RR 2.59;2.11–3.17). Albumin<3.5 was also associated with increased risk of all outcomes for ovarian and uterine cancer patients.
Conclusions The malnutrition definitions predicting the highest number of adverse post-operative outcomes varies by cancer type. Major complications, readmission, and reoperation were associated with BMI<18.5 alone for ovarian cancer (ESPEN2), with 10% recent weight loss and a normal or overweight BMI for uterine cancer (ACS), and with albumin<3.5 for all cancers. These criteria may be useful for cancer-specific pre-operative planning.
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