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 Jia1,2, *Ask Nordestgaard1, *Jae Moo Lee1, *Karien Meier1, *Nikolaos Kokoroskos1, *Aditya Napaporn Kongkaewpaisan1, *Manasnun Kongwibulwut1, *Ahmed Eid1, *Kelsey Han1, *Gabriel Rodriguez1, *Noelle Saillant1, *April Mendoza1, *Martin Rosenthal1, *Peter Fagenholz1, *David King1, George Velmahos1, Haytham Kaafarani1
1. Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery Massachusetts General Hospital, Boston, MA 2. Division of Emergency Surgery, Department of surgery, Shanghai Sixth People's Hospital, Shanghai, China

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<73), severe (GNRI 73 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 >2.5 folds increased mortality (OR=2.79, 95% CI 2.57-3.03), 2 folds increased DVT (OR=2.07, 95% CI 1.77-2.42) and nearly 2 folds increased ventilation requirement for >48 hours (OR=1.95, 95% CI 1.81-2.11). 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.

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