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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study
The Lancet Global Health, Volume 11, No. 3, Year 2023
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Description
Background: Malnutrition represents a key priority for global health policy, yet the impact of nutritional state on cancer surgery worldwide remains poorly described. We aimed to analyse the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer. Methods: We did an international, multicentre, prospective cohort study of patients undergoing elective surgery for colorectal or gastric cancer between April 1, 2018, and Jan 31, 2019. Patients were excluded if the primary pathology was benign, they presented with cancer recurrence, or if they underwent emergency surgery (within 72 h of hospital admission). Malnutrition was defined with the Global Leadership Initiative on Malnutrition criteria. The primary outcome was death or a major complication within 30 days of surgery. Multilevel logistic regression and a three-way mediation analysis were done to establish the relationship between country income group, nutritional status, and 30-day postoperative outcomes. Findings: This study included 5709 patients (4593 with colorectal cancer and 1116 with gastric cancer) from 381 hospitals in 75 countries. The mean age was 64·8 years (SD 13·5) and 2432 (42·6%) patients were female. Severe malnutrition was present in 1899 (33·3%) of 5709 patients, with a disproportionate burden in upper-middle-income countries (504 [44·4%] of 1135) and low-income and lower-middle-income countries (601 [62·5%] of 962). After adjustment for patient and hospital risk factors, severe malnutrition was associated with an increased risk of 30-day mortality across all country income groups (high income: adjusted odds ratio [aOR] 1·96 [95% CI 1·14–3·37], p=0·015; upper-middle income: 3·05 [1·45–6·42], p=0·003; low income and lower-middle income: 11·57 [5·87–22·80], p<0·0001). Severe malnutrition mediated an estimated 32% of early deaths in low-income and lower-middle-income countries (aOR 1·41 [95% CI 1·22–1·64]) and an estimated 40% of early deaths in upper-middle-income countries (1·18 [1·08–1·30]). Interpretation: Severe malnutrition is common in patients undergoing surgery for gastrointestinal cancers and is a risk factor for 30-day mortality following elective surgery for colorectal or gastric cancer. There is an urgent need to examine whether perioperative nutritional interventions can improve early outcomes following gastrointestinal cancer surgery worldwide. Funding: National Institute for Health Research Global Health Research Unit. © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
Authors & Co-Authors
Ghosh, Dhruv
Unknown Affiliation
Kingsley, Pamela Alice
Unknown Affiliation
Lapitan, Marie Carmela M.
Unknown Affiliation
Qureshi, Ahmad Uzair
Unknown Affiliation
Valparaiso, Apple P.
Unknown Affiliation
Pius, Riinu
Unknown Affiliation
Shaw, Catherine A.
Unknown Affiliation
Drake, Thomas M.
Unknown Affiliation
Norman, Lisa
Unknown Affiliation
Ademuyiwa, Adesoji O.
Unknown Affiliation
Adisa, Adewale O.
Unknown Affiliation
Aguilera, Maria Lorena
Unknown Affiliation
Al-Saqqa, Sara W.
Unknown Affiliation
Al-Slaibi, Ibrahim
Unknown Affiliation
Bhangu, Aneel Amir
Unknown Affiliation
Biccard, Bruce Mclure
Unknown Affiliation
Brocklehurst, Peter S.
Unknown Affiliation
Burden, Sorrel T.
Unknown Affiliation
Chu, Kathryn M.
Unknown Affiliation
Costas-Chavarri, Ainhoa
Unknown Affiliation
Dare, Anna J.
Unknown Affiliation
Elhadi, Muhammed K.
Unknown Affiliation
Fairfield, Cameron J.
Unknown Affiliation
Fitzgerald, James Edward F.
Unknown Affiliation
Glasbey, James C.
Unknown Affiliation
van Berge Henegouwen, Mark I.
Unknown Affiliation
Ingabire, Jc C.Allen
Unknown Affiliation
Kingham, Thomas Peter
Unknown Affiliation
Lawani, Ismaïl
Unknown Affiliation
Lieske, Bettina
Unknown Affiliation
Lilford, Richard J.
Unknown Affiliation
Magill, Laura
Unknown Affiliation
Maimbo, Mayaba
Unknown Affiliation
McLean, Kenneth A.
Unknown Affiliation
Moore, Rachel L.
Unknown Affiliation
Morton, Dion G.
Unknown Affiliation
Nepogodiev, Dmitri
Unknown Affiliation
Norrie, John D.T.
Unknown Affiliation
Ntirenganya, Faustin
Unknown Affiliation
Pata, Francesco
Unknown Affiliation
Pinkney, Thomas D.
Unknown Affiliation
Rajkumar, Kottayasamy Seenivasagam
Unknown Affiliation
Ramos-De La Medina, Antonio
Unknown Affiliation
Roberts, Tracey E.
Unknown Affiliation
Simoes, Joana F.F.
Unknown Affiliation
Spence, Richard Trafford
Unknown Affiliation
Smart, Neil J.
Unknown Affiliation
Tabiri, Stephen
Unknown Affiliation
Theodoratou, Evropi
Unknown Affiliation
Weiser, Thomas G.
Unknown Affiliation
Whitaker, John K.H.
Unknown Affiliation
Yenli, Edwin M.T.
Unknown Affiliation
Harrison, Ewen M.
Unknown Affiliation
Statistics
Citations: 10
Authors: 53
Identifiers
Doi:
10.1016/S2214-109X(22)00550-2
ISSN:
2214109X
Research Areas
Cancer
Food Security
Health System And Policy
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative
Participants Gender
Female