High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection Criteria and Nutritional Status Evaluation
2.2. Perioperative Patient Management Protocol
2.3. Postoperative Early Postoperative Outcomes and Survival Evaluation
2.4. Postoperative Long-Term Overall Survival Evaluation
2.5. Statistical Analyses
3. Results
3.1. Comparison of Patient Characteristics Based on GNRI Categories
3.2. Impact of GNRI Categories on Early Postoperative Outcomes and Postoperative Morbidity or Mortality
3.3. Impact of GNRI Categories on Long-Term Overall Survival
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Total (n = 199) | Severely Malnourished (n = 19) | Moderately/Mildly Malnourished (n = 109) | No Malnourishment (n = 71) | p-Value | ||
---|---|---|---|---|---|---|
Age (years), median (IQR) | 72 (8) | 76.0 (11) | 73.0 (9) | 71.0 (6) | 0.006 | |
Male gender, n (%) | 169 (56.1%) | 11 (57.9%) | 56 (51.4%) | 47 (66.2%) | 0.145 | |
BMI (kg/m2), median (IQR) | 22.93 (4.60) | 19.01 (4.33) | 22.78 (5.02) | 24.14 (3.71) | <0.001 | |
Abdominal surgery history, n (%) | 42 (21.1%) | 5 (26.3%) | 21 (19.3%) | 16 (22.5%) | 0.734 | |
Hypertension, n (%) | 115 (57.8%) | 6 (31.6%) | 68 (62.4%) | 41 (57.7%) | 0.043 | |
Diabetes mellitus, n (%) | 69 (34.7%) | 2 (10.5%) | 35 (32.1%) | 32 (45.1%) | 0.014 | |
Chronic kidney disease, n (%) | 20 (10.1%) | 3 (15.8%) | 11 (10.1%) | 6 (8.5%) | 0.640 | |
Coronary heart disease, n (%) | 40 (20.1%) | 5 (26.3%) | 17 (15.6%) | 18 (25.4%) | 0.217 | |
Chronic obstructive pulmonary disease, n (%) | 9 (4.5%) | 3 (15.8%) | 4 (3.7%) | 2 (2.8%) | 0.083 | |
ASA physical status, n (%) | 1 | 4 (2.0%) | 0 | 2 (1.8%) | 2 (2.8%) | 0.244 |
2 | 48 (24.1%) | 3 (15.8%) | 23 (21.1%) | 22 (31.0%) | ||
3 | 145 (72.9%) | 16 (84.2%) | 84 (77.1%) | 45 (63.4%) | ||
4 | 2 (1.0%) | 0 | 0 | 2 (2.8%) | ||
ECOG, n (%) | 0 | 180 (90.5%) | 13 (68.4%) | 98 (89.9%) | 69 (97.2%) | 0.002 |
1 | 16 (8.0%) | 6 (31.6%) | 8 (7.3%) | 2 (2.8%) | ||
2 | 3 (1.5%) | 0 | 3 (2.8%) | 0 | ||
Tumor Type, n (%) | Ampullary cancer | 57 (28.6%) | 7 (36.8%) | 32 (29.4%) | 18 (25.4%) | 0.943 |
CBD cancer | 41 (20.6%) | 3 (15.8%) | 25 (22.9%) | 13 (18.3%) | ||
Pancreatic cancer | 85 (42.7%) | 8 (42.1%) | 43 (39.4%) | 34 (47.9%) | ||
NEC | 6 (3.0%) | 0 | 3 (2.8%) | 3 (4.2%) | ||
Duodenal cancer | 10 (5.0%) | 1 (5.3%) | 6 (5.5%) | 3 (4.2%) | ||
Operation Type, n (%) | Open PD | 157 (78.9%) | 17 (89.5%) | 82 (75.2%) | 58 (81.7%) | 0.288 |
Minimal invasive PD | 42 (21.1%) | 2 (10.5%) | 27 (24.8%) | 13 (18.3%) |
Total (n = 199) | Severely Malnourished (n = 19) | Moderately/Mildly Malnourished (n = 109) | No Malnourishment (n = 71) | p-Value | ||
---|---|---|---|---|---|---|
Operative time (minutes), median (IQR) | 469.0 (192.0) | 596.0 (294.0) | 450.0 (153.0) | 480.0 (200.0) | 0.023 | |
Estimated blood loss (mL), mean ± SD | 358.5 ± 470.6 | 415.8 ± 334.5 | 345.6 ± 377.3 | 438.8 ± 610.3 | 0.188 | |
Tumor size (cm), mean ± SD | 3.0 ± 1.5 | 3.4 ± 1.4 | 2.9 ± 1.5 | 3.3 ± 1.6 | 0.024 | |
ΔGNRI%, median (IQR) | 4.5 (15.5) | −5.9 (16.4) | 2.5 (12.3) | 11.4 (12.3) | <0.001 | |
Postoperative stays (days), median (IQR) | 25.0 (14) | 33.0 (17.0) | 26.0 (16) | 22.0 (11.0) | <0.001 | |
Length of ICU stay (days), mean ± SD | 7.8 ± 15.8 | 8.7 ± 11.3 | 9.4 ± 20.1 | 5.1 ± 6.2 | 0.152 | |
Soft diet (days), mean ± SD | 10.5 ± 12.7 | 8.8 ± 3.5 | 11.2 ± 15.5 | 9.8 ± 8.9 | 0.561 | |
Ambulation (days), median (IQR) | 6.0 (3.0) | 8.0 (11.0) | 6.0 (4.0) | 6.0 (2.0) | 0.044 | |
TPN use (days), mean ± SD | 12.3 ± 12.4 | 14.5 ± 18.1 | 13.2 ± 12.7 | 10.4 ± 9.6 | 0.150 | |
Drain remove (days), median (IQR) | 21.0 (12.0) | 23.0 (15) | 22.0 (13.0) | 20.0 (10.0) | 0.039 | |
Grade 3b complication, n (%) | 42 (21.1%) | 8 (42.1%) | 24 (22.0%) | 10 (14.1%) | 0.027 | |
Pancreatic fistula, n (%) | 0 | 118 (59.3%) | 15 (78.9%) | 62 (56.9%) | 41 (57.7%) | 0.372 |
1 | 48 (24.1%) | 3 (15.8%) | 27 (24.8%) | 18 (25.4%) | ||
2 | 21 (10.6%) | 1 (5.3%) | 10 (9.2%) | 10 (14.1%) | ||
3 | 12 (6.0%) | 0 | 10 (9.2%) | 2 (2.8%) | ||
Postoperative pulmonary complication, n (%) | 21 (10.6%) | 5 (26.3%) | 13 (11.9%) | 3 (4.2%) | 0.016 | |
Surgical site infection, n (%) | 71 (35.7%) | 8 (42.1%) | 44 (40.4%) | 19 (26.8%) | 0.146 | |
Postoperative bleeding, n (%) | 17 (8.5%) | 1 (5.3%) | 11 (10.1%) | 5 (7.0%) | 0.670 | |
Delay gastric emptying, n (%) | 42 (21.1%) | 7 (36.8%) | 20 (18.3%) | 15 (21.1%) | 0.190 | |
30-day mortality, n (%) | 5 (2.5%) | 0 | 3 (2.8%) | 2 (2.8%) | 1.000 | |
1-year mortality, n (%) | 101 (50.8%) | 15 (78.9%) | 57 (52.3%) | 29 (40.8%) | 0.011 |
Variables | Unadjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value |
---|---|---|---|---|
Age | 1.04 (0.98–1.10) | 0.219 | — | |
Sex (Male) | 1.45 (0.72–2.93) | 0.303 | — | |
BMI | 1.00 (0.92–1.10) | 0.848 | — | |
Hypertension | 1.24 (0.62–2.5) | 0.544 | — | |
Diabetes mellitus | 0.81 (0.39–1.68) | 0.569 | — | |
ASA physical status | ||||
I–II | Reference | Reference | ||
III–V | 4.18 (1.41–12.38) | 0.010 | 3.56 (1.18–10.78) | 0.025 |
GNRI score | — | |||
No malnourishment | Reference | Reference | ||
Moderately/mildly malnourished | 1.72 (0.77–3.86) | 0.448 | 1.71 (0.74–3.96) | 0.210 |
Severely malnourished | 4.43 (1.43–13.73) | 0.010 | 3.44 (1.06–11.22) | 0.040 |
MIS approach † | 0.70 (0.29–1.70) | 0.429 | — | |
Operative time | ||||
Time < 480 min | Reference | Reference | ||
Time > 480 min | 2.02 (1.01–4.06) | 0.048 | 1.63 (0.77–3.43) | 0.202 |
Estimated blood loss | ||||
<400 mL | Reference | — | ||
>400 mL | 2.05 (1.01–4.16) | 0.046 | 1.87 (0.89–3.95) | 0.101 |
Variables | Unadjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value |
---|---|---|---|---|
Age | 1.09 (1.01–1.19) | 0.038 | 1.06 (0.98–1.15) | 0.159 |
Sex (Male) | 3.55 (1.15–10.97) | 0.028 | 4.40 (1.37–14.15) | 0.013 |
BMI | 1.00 (0.88–1.13) | 0.996 | — | |
Hypertension | 1.53 (0.59–3.96) | 0.386 | — | |
Diabetes mellitus | 0.283 (0.08–0.99) | 0.049 | 0.37 (0.10–1.36) | 0.134 |
ASA physical status | ||||
I–II | Reference | — | ||
III–V | 3.71 (0.83–16.52) | 0.085 | — | |
GNRI score | ||||
No malnourishment | Reference | Reference | ||
Moderately/mildly malnourished | 3.07 (0.84–11.19) | 0.089 | 3.04 (0.80–11.57) | 0.102 |
Severely malnourished | 8.10 (1.73–37.86) | 0.008 | 5.91 (1.15–30.47) | 0.034 |
MIS approach † | 0.59 (0.17–2.12) | 0.423 | — | |
Operative time | ||||
Time < 480 min | Reference | — | ||
Time > 480 min | 2.34 (0.90–6.08) | 0.080 | — | |
Estimated blood loss | ||||
<400 mL | Reference | — | ||
>400 mL | 1.87 (0.74–4.70) | 0.185 | — |
Variables | Unadjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value |
---|---|---|---|---|
Age | 1.06 (1.04–1.11) | 0.035 | 1.05 (0.99–1.11) | 0.118 |
Sex (Male) | 1.31 (0.74–2.34) | 0.354 | — | |
BMI | 0.98 (0.90–1.06) | 0.541 | — | |
Hypertension | 1.16 (0.65–2.1) | 0.605 | — | |
Diabetes mellitus | 0.851 (0.47–1.55) | 0.598 | — | |
ASA physical status | ||||
I–II | Reference | — | ||
III–V | 1.74 (0.89–3.40) | 0.109 | — | |
GNRI score | ||||
No malnourished | Reference | Reference | ||
Moderate/mild malnourished | 2.01 (1.06–3.81) | 0.033 | 1.96 (1.01–3.80) | 0.047 |
Severe malnourished | 4.37 (1.51–12.69) | 0.007 | 3.54 (1.18–10.59) | 0.024 |
MIS approach † | 0.45 (0.21–0.96) | 0.040 | 0.42 (0.19–0.92) | 0.030 |
Operative time | ||||
Time < 480 min | Reference | — | ||
Time > 480 min | 1.71 (0.97–3.04) | 0.065 | — | |
Estimated blood loss | ||||
<400 mL | Reference | — | ||
>400 mL | 1.33 (0.72–2.45) | 0.365 | — |
Variables | Unadjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value |
---|---|---|---|---|
Age | 1.03 (0.98–1.09) | 0.286 | — | |
Sex (Male) | 1.19 (0.68–2.09) | 0.540 | — | |
BMI | 0.91 (0.84–0.99) | 0.022 | 0.96 (0.88–1.04) | 0.287 |
Hypertension | 0.70 (0.40–1.23) | 0.211 | — | |
Diabetes mellitus | 0.49 (0.27–0.88) | 0.018 | 0.59 (0.32–1.09) | 0.092 |
ASA physical status | ||||
I–II | Reference | — | ||
III–V | 1.16 (0.61–2.18) | 0.653 | — | |
GNRI score | ||||
No malnourishment | Reference | Reference | ||
Moderately/mildly malnourished | 1.59 (0.87–2.90) | 0.134 | 1.41 (0.75–2.62) | 0.284 |
Severely malnourished | 5.43 (1.64–18.04) | 0.006 | 3.65 (1.01–13.13) | 0.048 |
MIS approach † | 1.09 (0.55–2.15) | 0.812 | — | |
Operative time | ||||
Time < 480 min | Reference | — | ||
Time > 480 min | 0.87 (0.50–1.52) | 0.625 | — | |
Estimated blood loss | ||||
<400 mL | Reference | — | ||
>400 mL | 1.55 (0.84–2.86) | 0.161 | — |
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Wang, M.-H.; Chen, C.-Y.; Lin, Y.-H.; Liu, Y.-W.; Liu, Y.-Y.; Li, W.-F.; Lin, C.-T.; Huang, S.-W.; Yeh, C.-H.; Yin, S.-M. High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies. J. Clin. Med. 2025, 14, 655. https://doi.org/10.3390/jcm14020655
Wang M-H, Chen C-Y, Lin Y-H, Liu Y-W, Liu Y-Y, Li W-F, Lin C-T, Huang S-W, Yeh C-H, Yin S-M. High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies. Journal of Clinical Medicine. 2025; 14(2):655. https://doi.org/10.3390/jcm14020655
Chicago/Turabian StyleWang, Ming-Hung, Chien-Yu Chen, Yu-Hung Lin, Yueh-Wei Liu, Yu-Yin Liu, Wei-Feng Li, Chang-Ting Lin, Szu-Wei Huang, Cheng-Hsi Yeh, and Shih-Min Yin. 2025. "High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies" Journal of Clinical Medicine 14, no. 2: 655. https://doi.org/10.3390/jcm14020655
APA StyleWang, M.-H., Chen, C.-Y., Lin, Y.-H., Liu, Y.-W., Liu, Y.-Y., Li, W.-F., Lin, C.-T., Huang, S.-W., Yeh, C.-H., & Yin, S.-M. (2025). High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies. Journal of Clinical Medicine, 14(2), 655. https://doi.org/10.3390/jcm14020655