The Predictive Effect Of Geriatric Nutritional Risk Index In Post-operative Complications After Pancreaticoduodenectomy Among Elderly Patients

Background:Along with the extending of human life expectancy,the proportion of elderly patients suffering from pancreatic and periampullary cancer is ever-increasing.As the radical treatment for pancreatic and periampullary cancer,pancreatoduodenectomy(PD)is gradually safer and more effective.However,the high incidences of morbidity and mortality involved with PD are still great challenges for both doctors and patients,especially for elderly patients.Aging and disease could both cause great nutritional risks,while the nutritional status of patients before PD is closely related to postoperative recovery and clinical outcome.Therefore,the nutritional status of elderly patients with PD should be concentrated more attention.However,no standards have been established for screening nutritional risks of elderly patients undergoing PD.If the Geriatric Nutritional Risk Index(GNRI)of elderly patients are related to post-operative complications of PD,and if GNRI has predictive value for complications of PD have not yet been demonstrated.For these purpose we carried out this research.Methods:Clinical data of elderly patients suffering from pancreatic and periampullary cancer who underwent PD during December 2013 to December 2018 in the Second Affiliated Hospital of Dalian Medical University were retrospectively analyzed.Variables related to nutritional status of elderly patients before PD were focused.All elderly patients were divided into two groups depending on whether complications occurred or not,then univariate analysis and multivariate logistic regression analysis were performed to confirm independent risk factors.The predictive value of this independent risk factor for complications after PD was determined by receiver operating characteristic curve.According to the critical value,comparison was made to investigate the differences in the incidence of certain complications between two groups.Subsequently,elderly patients with complications after PD were divided into two groups according to the severity of complications.Another critical value of this independent risk factor was also calculated by receiver operating characteristic curve.By using another critical value,the differences in length of stay after PD and hospitalization cost between serious complications group and mild complications group were further compared.Results:1.Diabetes(OR=2.592,95%CI 1.005-6.683,P=0.049),GNRI(OR=0.897,95% CI 0.846-0.951,P<0.001)and Operation periods(OR=1.443,95% CI 1.085-1.919,P=0.012)were independent risk factors for complications after PD in elderly patients.And GNRI was related to the nutritional status of elderly patients undergoing PD.2.The predictive value of GNRI in overall complications of elderly patients with PD: sensitivity 79.6%,specificity 57.3%,and the critical value of GNRI to distinguish complications from non-complications 97.0.The incidence of postoperative pancreatic fistula and surgical site infections in low GNRI elderly patients(GNRI<97.0)were 26.8% and 25.4% respectively,significantly higher than those in high GNRI elderly patients(GNRI≥97.0)which were 9.4% and 3.8%(P=0.016;P<0.001).3.The predictive value of GNRI in forecast the severity of complications in elderly patients with PD: sensitivity 84.6%,specificity 77.8%.The critical value of GNRI in distinguishing the severity of complications was 88.3.The length of stay after PD and hospitalization cost of low GNRI elderly patients(GNRI<88.3)were 27(19)days and 129789.63±40568.45 yuan respectively,which were both significantly increased compared with high GNRI elderly patients(GNRI≥88.3)for 18(8)days and 90928.83±21463.84 yuan(P=0.024;P=0.001).Conclusion:GNRI was an independent risk factor for post-operative complications in elderly patients with PD,and Diabetes and operation periods were another two kinds of independent risk factors.GNRI had a good predictive value for the occurrence of complications after PD in elderly patients by using the critical value of 97.0.Compared with elderly patients with high GNRI,elderly patients with low GNRI were more likely to suffer postoperative pancreatic fistula and surgical site infections after PD.GNRI also had a good predictive value for the severity of post-operative complications in elderly patients with PD.With a critical value of 88.3,elderly patients with low GNRI were likely to experience more serious post-operative complications,longer length of stay and spend more on hospitalization than elderly patients of high GNRI after PD.In conclusion,surgeons should pay more attention to the nutritional status of elderly patients with PD during hospital stay,and timely perform nutritional risk assessments.And GNRI may be a convenient and reliable method for clinical practice.