New England Surgical Society

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The Geriatric Nutritional Risk Index is a Powerful Predictor of Adverse Outcome in the Elderly Emergency Surgery Patient
*Zhenyi Jia, *Ask Nordestgaard, *Jae Moo Lee, *Karien Meier, *Nikolaos Kokoroskos, *Aditya Napaporn Kongkaewpaisan, *Manasnun Kongwibulwut, *Ahmed Eid, *Kelsey Han, *Gabriel Rodriguez, *Noelle Saillant, *April Mendoza, *Martin Rosenthal, *Peter Fagenholz, *David King, George Velmahos, Haytham Kaafarani
Massachusetts General Hospital, Boston, MA

Objective: To examine the effect of malnutrition, as measured by the Geriatric Nutritional Risk Index (GNRI), on postoperative outcomes in elderly emergency surgery (ES) patients.
Design/Setting: Multicenter retrospective 2007-2016 ACS-NSQIP cohort study.
Patients: All patients ≥ 65 years undergoing ES, as defined by ACS-NSQIP, and without missing height, weight, or preoperative albumin data were included. The GNRI was calculated as [1.489 albumin (g/L)] + [41.7 (weight/ ideal weight)]. Patients were divided into four malnutrition groups: very severe (GNRI<70), severe (GNRI 70 to <82), moderate (GNRI 82 to <92), mild (GNRI 92-98) versus normal (GNRI>98).
Main Outcome Measure(s): Univariate then multivariable logistic regression models were created to study the relationship between malnutrition and 30-day postoperative mortality and complications. We adjusted for demographics, comorbidities, laboratory tests, and operative complexity.
Results: Out of 5,457,202 patients, a total of 82,725 were included: 18, 22, 19, and 7% with mild, moderate, severe and very severe malnutrition, respectively. As malnutrition worsened from mild to very severe, the risk of mortality and all postoperative complications incrementally and significantly increased [Figure 1, all p-values<0.05]. For example, patients with very severe malnutrition had >3 folds increased mortality [OR 3.43 (3.15-3.74), and>2 folds increased respiratory failure (requiring ventilation for >48 hours) [OR 2.21 (2.03-2.41)] . GNRI predicted outcome significantly better than either albumin or body mass index.
Conclusion: Malnutrition, measured by GNRI, is a powerful predictor of adverse outcome in the elderly ES patient and should be given great consideration in preoperative patient and family counseling.
Figure 1


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