Malnutrition as a risk factor of adverse postoperative outcomes in patients undergoing hepatic resection: analysis of US hospitals

Patients with liver cancer or space-occupying cysts suffer from malnutrition due to compression of gastric and digestive structures, liver and cancer-mediated dysmetabolism, and impaired nutrient absorption. As proportion of these patients requires removal of lesions through hepatic resection, it is important to evaluate the effects of malnutrition on post-hepatectomy outcomes. In our study approach, 2011-2017 National Inpatient Sample was used to isolate in-hospital hepatectomy cases, which were stratified using malnutrition (composite of malnutrition, sarcopenia and weight loss/cachexia). The malnutrition-absent controls were matched to cases using nearest neighbour propensity score matching method and compared with the following endpoints: mortality, length of stay, hospitalisation costs and postoperative complications. There were 2531 patients in total who underwent hepatectomy with matched number of controls from the database; following the match, malnutrition cohort (compared with controls) was more likely to experience in-hospital death (6 center dot 60 % v. 5 center dot 25 % P < 0 center dot 049, OR 1 center dot 27, 95 % CI 1 center dot 01, 1 center dot 61) and was more likely to have higher length of stay (18 center dot 10 d v. 9 center dot 32 d, P < 0 center dot 001) and hospitalisation costs ($278 780 v. $150 812, P < 0 center dot 001). In terms of postoperative complications, malnutrition cohort was more likely to experience bleeding (6 center dot 52 % v. 3 center dot 87 %, P < 0 center dot 001, OR 1 center dot 73, 95 % CI 1 center dot 34, 2 center dot 24), infection (6 center dot 64 % v. 2 center dot 49 %, P < 0 center dot 001, OR 2 center dot 79, 95 % CI 2 center dot 07, 3 center dot 74), wound complications (4 center dot 5 % v. 1 center dot 38 %, P < 0 center dot 001, OR 3 center dot 36, 95 % CI 2 center dot 29, 4 center dot 93) and respiratory failure (9 center dot 40 % v. 4 center dot 11 %, P < 0 center dot 001, OR 2 center dot 42, 95 % CI 1 center dot 91, 3 center dot 07). In multivariate analysis, malnutrition was associated with higher mortality (P < 0 center dot 028, adjusted OR 1 center dot 3, 95 % CI 1 center dot 03, 1 center dot 65). Thus, we conclude that malnutrition is a risk factor of postoperative mortality in patients undergoing hepatectomy.