Relation of Malnutrition on Septic Older Adults in Emergency Gastrointestinal Surgery: A Modified Global Leadership Initiative on Malnutrition Analysis

INTRODUCTION: Malnutrition in older adults has significant ramifications for surgical outcomes. The incidence of malnutrition is up to 30% in emergent gastrointestinal surgery (EGS). This study aims to investigate malnutrition's correlation on outcomes of older adults with preoperative sepsis undergoing EGS.

METHODS: Adults aged ≥ 65 y who had preoperative sepsis were included. The Global Leadership Initiative on Malnutrition (GLIM) introduced criteria to diagnose malnutrition. We used a modified GLIM (mGLIM) using the National Surgical Quality Improvement Project database. The mGLIM includes (1) body mass index ≤ 20 kg/m 2 for age ≤ 70 y and body mass index ≤ 22 kg/m 2 for age ≥ 71 y, (2) weight loss >10% within the past 6 mo, (3) admission albumin ≤ 3.5 g/dL, and (4) EGS as an acute disease marker. Multivariate regression explored the relationship of malnutrition on mortality, length of stay, and complications.

RESULTS: A total of 26,801 patients were included. Demographically, female patients included 58% (n = 15,501). African American patients consisted of 8.0% (n = 2133), and Caucasian patients accounted for 75.7% (n = 20,295) of the study population. Small bowel cases were 32.1% (n = 8609), and colorectal cases represented 76.5% (n = 20,490) of all cases. Malnourished patients made up of 1.8% (n = 481) of all patients. Multivariate regression revealed malnourished patients have higher chance of mortality for small bowel (P = 0.001, confidence interval [CI] 1.31-2.69) and colorectal (P < 0.001, CI 1.47-2.39) procedures, and higher likelihood of complications for colorectal (P = 0.001, CI 1.31-2.65) cases.

CONCLUSIONS: Our analysis shows that malnutrition, as identified by mGLIM criteria, is associated with higher mortality and complication rates after EGS. The mGLIM criteria could be a prognostic tool for adverse outcomes in malnutrition-risk patients.