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Annals of Surgery logoLink to Annals of Surgery
. 1984 Mar;199(3):299–305. doi: 10.1097/00000658-198403000-00009

Clinical significance of preoperative nutritional status in 215 noncancer patients.

I Warnold, K Lundholm
PMCID: PMC1353396  PMID: 6703791

Abstract

Preoperative nutritional status was assessed by: the percentage weight loss (% WL), body weight in relation to reference weight (WI), arm muscle circumference (AMC), and S-albumin (S-Alb) in a prospective study of 215 noncancer patients classified into three groups according to type of surgery: major vascular, minor vascular, and abdominal. The clinical significance of the nutritional markers was assessed by correlations to postoperative outcome and the time spent in the hospital after surgery. The influence of age on nutritional markers and clinical variables was evident but was ruled out in all correlations. If malnutrition was classified as two or more abnormal values in the nutritional markers (% WL, WI, AMC, S-Alb), the overall frequency was 12%, highest in the major vascular surgery group (18%) and lowest in the minor vascular group (4%). Patients with low nutritional status stayed an average of 29 days in the hospital compared to 14 days if the nutritional status was normal (p less than 0.01). The overall complication frequency was higher in patients with low nutritional status compared to normal status (48% and 23%, respectively, p less than 0.01). The frequency of serious complications was 31% in undernourished and 9% in well-nourished patients (p less than 0.05). Various nonnutritional variables such as age, diagnosis, and duration of surgery were shown to increase the predictive ability of nutritional status. The results of this study confirm that nutritional state per se is predictive for postoperative outcome even when variables were stabilized for different backgrounds with covariation to nutritional status.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker J. P., Detsky A. S., Wesson D. E., Wolman S. L., Stewart S., Whitewell J., Langer B., Jeejeebhoy K. N. Nutritional assessment: a comparison of clinical judgement and objective measurements. N Engl J Med. 1982 Apr 22;306(16):969–972. doi: 10.1056/NEJM198204223061606. [DOI] [PubMed] [Google Scholar]
  2. Bengtsson C., Hultén B., Larsson B., Noppa H., Steen B., Warnold I. Nya längd-vikttabeller för medelålders och äldre män och kvinnor. Lakartidningen. 1981 Sep 9;78(37):3152–3154. [PubMed] [Google Scholar]
  3. Bistrian B. R., Blackburn G. L., Hallowell E., Heddle R. Protein status of general surgical patients. JAMA. 1974 Nov 11;230(6):858–860. [PubMed] [Google Scholar]
  4. Bistrian B. R., Blackburn G. L., Vitale J., Cochran D., Naylor J. Prevalence of malnutrition in general medical patients. JAMA. 1976 Apr 12;235(15):1567–1570. [PubMed] [Google Scholar]
  5. Bruce A., Andersson M., Arvidsson B., Isaksson B. Body composition. Prediction of normal body potassium, body water and body fat in adults on the basis of body height, body weight and age. Scand J Clin Lab Invest. 1980 Sep;40(5):461–473. doi: 10.3109/00365518009101869. [DOI] [PubMed] [Google Scholar]
  6. Buzby G. P., Mullen J. L., Matthews D. C., Hobbs C. L., Rosato E. F. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980 Jan;139(1):160–167. doi: 10.1016/0002-9610(80)90246-9. [DOI] [PubMed] [Google Scholar]
  7. Harvey K. B., Moldawer L. L., Bistrian B. R., Blackburn G. L. Biological measures for the formulation of a hospital prognostic index. Am J Clin Nutr. 1981 Oct;34(10):2013–2022. doi: 10.1093/ajcn/34.10.2013. [DOI] [PubMed] [Google Scholar]
  8. Hessov I. Energy and protein intake in elderly patients in an orthopedic surgical ward. Acta Chir Scand. 1977;143(3):145–149. [PubMed] [Google Scholar]
  9. Hill G. L., Blackett R. L., Pickford I., Burkinshaw L., Young G. A., Warren J. V., Schorah C. J., Morgan D. B. Malnutrition in surgical patients. An unrecognised problem. Lancet. 1977 Mar 26;1(8013):689–692. doi: 10.1016/s0140-6736(77)92127-4. [DOI] [PubMed] [Google Scholar]
  10. Isaksson B. How to avoid malnutrition during hospitalization? Hum Nutr Appl Nutr. 1982 Oct;36(5):367–373. [PubMed] [Google Scholar]
  11. Meakins J. L., Pietsch J. B., Bubenick O., Kelly R., Rode H., Gordon J., MacLean L. D. Delayed hypersensitivity: indicator of acquired failure of host defenses in sepsis and trauma. Ann Surg. 1977 Sep;186(3):241–250. doi: 10.1097/00000658-197709000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Misra D. P., Loudon J. M., Staddon G. E. Albumin metabolism in elderly patients. J Gerontol. 1975 May;30(3):304–306. doi: 10.1093/geronj/30.3.304. [DOI] [PubMed] [Google Scholar]
  13. Mullen J. L., Buzby G. P., Waldman M. T., Gertner M. H., Hobbs C. L., Rosato E. F. Prediction of operative morbidity and mortality by preoperative nutritional assessment. Surg Forum. 1979;30:80–82. [PubMed] [Google Scholar]
  14. Mullen J. L., Gertner M. H., Buzby G. P., Goodhart G. L., Rosato E. F. Implications of malnutrition in the surgical patient. Arch Surg. 1979 Feb;114(2):121–125. doi: 10.1001/archsurg.1979.01370260011001. [DOI] [PubMed] [Google Scholar]
  15. Simms J. M., Smith J. A., Woods H. F. A modified prognostic index based upon nutritional measurements. Clin Nutr. 1982 Mar;1(1):71–79. doi: 10.1016/0261-5614(82)90007-3. [DOI] [PubMed] [Google Scholar]
  16. Symreng T. Arm anthropometry in a large reference population and in surgical patients. Clin Nutr. 1982 Dec;1(3):211–219. doi: 10.1016/0261-5614(82)90015-2. [DOI] [PubMed] [Google Scholar]
  17. Symreng T., Groth O., Norr A., Schildt B., Zetterqvist H. Delayed hypersensitivity. A critical evaluation of five recall antigens in a large reference population. Clin Nutr. 1983 Mar;1(4):265–273. doi: 10.1016/0261-5614(83)90004-3. [DOI] [PubMed] [Google Scholar]
  18. Warnold I., Falkheden T., Hultén B., Isaksson B. Energy intake and expenditure in selected groups of hospital patients. Am J Clin Nutr. 1978 May;31(5):742–749. doi: 10.1093/ajcn/31.5.742. [DOI] [PubMed] [Google Scholar]
  19. Warnold I., Lundholm K., Scherstén T. Energy balance and body composition in cancer patients. Cancer Res. 1978 Jun;38(6):1801–1807. [PubMed] [Google Scholar]
  20. Weinsier R. L., Hunker E. M., Krumdieck C. L., Butterworth C. E., Jr Hospital malnutrition. A prospective evaluation of general medical patients during the course of hospitalization. Am J Clin Nutr. 1979 Feb;32(2):418–426. doi: 10.1093/ajcn/32.2.418. [DOI] [PubMed] [Google Scholar]

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