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Published in: Journal of Anesthesia 3/2023

16-03-2023 | Heart Surgery | Original Article

Effects of preoperative nutritional status on disability-free survival after cardiac and thoracic aortic surgery: a prospective observational study

Authors: Hideaki Kawanishi, Mitsuru Ida, Yusuke Naito, Masahiko Kawaguchi

Published in: Journal of Anesthesia | Issue 3/2023

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Abstract

Purpose

Preoperative malnutrition is associated with postoperative complications, prolonged intensive care unit stay, and mortality, leading to functional disability after non-cardiac surgery. However, its effects on cardiac and thoracic aortic surgery outcomes remain unknown. We examined the effects of preoperative malnutrition on disability-free survival after surgery and assessed the perioperative 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS2.0) score based on the preoperative nutritional status.

Methods

We included individuals aged ≥ 55 years who underwent elective cardiac and/or thoracic aortic surgery between April 1, 2016 and December 28, 2018 in a tertiary center. The nutritional status was assessed preoperatively using the Mini Nutritional Assessment Short Form, with scores < 12 points indicating a poor nutritional status. The JapanSCORE2 was calculated for surgical risk prediction. Our primary outcome was disability-free survival 1 year after surgery (WHODAS2.0 score: < 16%). The odds ratio of poor nutritional status for disability-free survival was calculated using multiple logistic regression analysis after adjusting for age, JapanSCORE2, and duration of surgery.

Results

One hundred patients were followed up for 1 year. Preoperatively, 41 of them had a poor nutritional status. The disability-free survival rates 1 year postoperatively were 46.3% (19/41) and 64.4% (38/59) in patients with and without poor preoperative nutritional status, respectively. The adjusted odds ratio of poor nutritional status for disability-free survival at 1 year after surgery was 0.42 (95% confidence interval, 0.17–0.99).

Conclusion

Patients with a poor preoperative nutritional status had less likely to show disability-free survival 1 year after cardiac and thoracic aortic surgery.
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Literature
1.
go back to reference Chan PG, Seese L, Aranda-Michel E, Sultan I, Gleason TG, Wang Y, Thoma F, Kilic A. Operative mortality in adult cardiac surgery: is the currently utilized definition justified? J Thorac Dis. 2021;13:5582–91.CrossRefPubMedPubMedCentral Chan PG, Seese L, Aranda-Michel E, Sultan I, Gleason TG, Wang Y, Thoma F, Kilic A. Operative mortality in adult cardiac surgery: is the currently utilized definition justified? J Thorac Dis. 2021;13:5582–91.CrossRefPubMedPubMedCentral
2.
go back to reference Writing Committee for the VISION Study Investigators, Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, Srinathan SK, Walsh M, Abraham V, Pearse R, Wang CY, Sessler DI, Kurz A, Szczeklik W, Berwanger O, Villar JC, Malaga G, Garg AX, Chow CK, Ackland G, Patel A, Borges FK, Belley-Cote EP, Duceppe E, Spence J, Tandon V, Williams C, Sapsford RJ, Polanczyk CA, Tiboni M, Alonso-Coello P, Faruqui A, Heels-Ansdell D, Lamy A, Whitlock R, LeManach Y, Roshanov PS, McGillion M, Kavsak P, McQueen MJ, Thabane L, Rodseth RN, Buse GL, Bhandari M, Garutti I, Jacka MJ, Schünemann HJ, Cortes OL, Coriat P, Dvirnik N, Botto F, Pettit S, Jaffe AS, Guyatt GH. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2017;317:1642–51.CrossRef Writing Committee for the VISION Study Investigators, Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, Srinathan SK, Walsh M, Abraham V, Pearse R, Wang CY, Sessler DI, Kurz A, Szczeklik W, Berwanger O, Villar JC, Malaga G, Garg AX, Chow CK, Ackland G, Patel A, Borges FK, Belley-Cote EP, Duceppe E, Spence J, Tandon V, Williams C, Sapsford RJ, Polanczyk CA, Tiboni M, Alonso-Coello P, Faruqui A, Heels-Ansdell D, Lamy A, Whitlock R, LeManach Y, Roshanov PS, McGillion M, Kavsak P, McQueen MJ, Thabane L, Rodseth RN, Buse GL, Bhandari M, Garutti I, Jacka MJ, Schünemann HJ, Cortes OL, Coriat P, Dvirnik N, Botto F, Pettit S, Jaffe AS, Guyatt GH. Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2017;317:1642–51.CrossRef
3.
go back to reference Myles P, Bellomo R, Corcoran T, Forbes A, Wallace S, Peyton P, Christophi C, Story D, Leslie K, Serpell J, McGuinness S, Parke R, Australian and New Zealand College of Anaesthetists Clinical Trials Network, and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trial. BMJ Open. 2017;7:e015358.93.CrossRef Myles P, Bellomo R, Corcoran T, Forbes A, Wallace S, Peyton P, Christophi C, Story D, Leslie K, Serpell J, McGuinness S, Parke R, Australian and New Zealand College of Anaesthetists Clinical Trials Network, and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trial. BMJ Open. 2017;7:e015358.93.CrossRef
4.
go back to reference Joosten A, Delaporte A, Mortier J, Ickx B, Van Obbergh L, Vincent J, Cannesson M, Rinehart J, Van der Linden P. Long-term impact of crystalloid versus colloid solutions on renal function and disability-free survival after major abdominal surgery. Anesthesiology. 2019;130:227–36.CrossRefPubMed Joosten A, Delaporte A, Mortier J, Ickx B, Van Obbergh L, Vincent J, Cannesson M, Rinehart J, Van der Linden P. Long-term impact of crystalloid versus colloid solutions on renal function and disability-free survival after major abdominal surgery. Anesthesiology. 2019;130:227–36.CrossRefPubMed
5.
go back to reference Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36:623–50.CrossRefPubMed Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36:623–50.CrossRefPubMed
6.
go back to reference Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC, MNA-International Group. Validation of the Mini Nutritional Assessment short-form (MNASF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13:782–8.CrossRefPubMed Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC, MNA-International Group. Validation of the Mini Nutritional Assessment short-form (MNASF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13:782–8.CrossRefPubMed
8.
go back to reference Ida M, Naito Y, Tanaka Y, Inoue S, Kawaguchi M. Factors associated with functional disability or mortality after elective noncardiac surgery: a prospective cohort study. Can J Anaesth. 2022;69:704–14.CrossRefPubMed Ida M, Naito Y, Tanaka Y, Inoue S, Kawaguchi M. Factors associated with functional disability or mortality after elective noncardiac surgery: a prospective cohort study. Can J Anaesth. 2022;69:704–14.CrossRefPubMed
9.
go back to reference Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Deryagin MN, Lomivorotov VN, Karaskov AM. Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc Thorac Surg. 2013;16:612–8.CrossRefPubMedPubMedCentral Lomivorotov VV, Efremov SM, Boboshko VA, Nikolaev DA, Vedernikov PE, Deryagin MN, Lomivorotov VN, Karaskov AM. Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery. Interact Cardiovasc Thorac Surg. 2013;16:612–8.CrossRefPubMedPubMedCentral
10.
go back to reference Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31:345–50.CrossRefPubMed Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31:345–50.CrossRefPubMed
11.
go back to reference Motomura N, Miyata H, Tsukihara H, Takamoto S, Japan Cardiovascular Surgery Database Organization. Risk model of valve surgery in Japan using the Japan Adult Cardiovascular Surgery Database. J Heart Valve Dis. 2010;19:684–91.PubMed Motomura N, Miyata H, Tsukihara H, Takamoto S, Japan Cardiovascular Surgery Database Organization. Risk model of valve surgery in Japan using the Japan Adult Cardiovascular Surgery Database. J Heart Valve Dis. 2010;19:684–91.PubMed
13.
go back to reference Shulman MA, Kasza J, Myles PS. Defining the minimal clinically important difference and patient-acceptable symptom state score for disability assessment in surgical patients. Anesthesiology. 2020;132:1362–70.CrossRefPubMed Shulman MA, Kasza J, Myles PS. Defining the minimal clinically important difference and patient-acceptable symptom state score for disability assessment in surgical patients. Anesthesiology. 2020;132:1362–70.CrossRefPubMed
14.
go back to reference McIsaac DI, Taljaard M, Bryson GL, Beaulé PE, Gagné S, Hamilton G, Hladkowicz E, Huang A, Joanisse JA, Lavallée LT, MacDonald D, Moloo H, Thavorn K, van Walraven C, Yang H, Forster AJ. Frailty as a predictor of death or new disability after surgery: a prospective cohort study. Ann Surg. 2020;271:283–9.CrossRefPubMed McIsaac DI, Taljaard M, Bryson GL, Beaulé PE, Gagné S, Hamilton G, Hladkowicz E, Huang A, Joanisse JA, Lavallée LT, MacDonald D, Moloo H, Thavorn K, van Walraven C, Yang H, Forster AJ. Frailty as a predictor of death or new disability after surgery: a prospective cohort study. Ann Surg. 2020;271:283–9.CrossRefPubMed
15.
go back to reference McIsaac DI, Taljaard M, Bryson GL, Beaulé PE, Gagne S, Hamilton G, Hladkowicz E, Huang A, Joanisse J, Lavallée LT, MacDonald D, Moloo H, Thavorn K, van Walraven C, Yang H, Forster AJ. Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study. Br J Anaesth. 2020;125:704–11.CrossRefPubMed McIsaac DI, Taljaard M, Bryson GL, Beaulé PE, Gagne S, Hamilton G, Hladkowicz E, Huang A, Joanisse J, Lavallée LT, MacDonald D, Moloo H, Thavorn K, van Walraven C, Yang H, Forster AJ. Frailty and long-term postoperative disability trajectories: a prospective multicentre cohort study. Br J Anaesth. 2020;125:704–11.CrossRefPubMed
16.
go back to reference Shimakura K, Minami K, Yoshitani K, Ohnishi Y, Iida H. Cardiac surgery improves the postoperative frailty score of frail patients. J Anesth. 2022;36:186–93.CrossRefPubMed Shimakura K, Minami K, Yoshitani K, Ohnishi Y, Iida H. Cardiac surgery improves the postoperative frailty score of frail patients. J Anesth. 2022;36:186–93.CrossRefPubMed
17.
go back to reference Milne B, de Carvalho JL, Ayis S, Chaubey S, Khan H, Kunst G. Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study. Br J Anaesth. 2022;128:949–58.CrossRefPubMedPubMedCentral Milne B, de Carvalho JL, Ayis S, Chaubey S, Khan H, Kunst G. Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study. Br J Anaesth. 2022;128:949–58.CrossRefPubMedPubMedCentral
18.
go back to reference McGrail K, Bryan S, Davis J. Let’s all go to the PROM: the case for routine patient-reported outcome measurement in Canadian healthcare. Healthc Pap. 2011;11:8–18.CrossRefPubMed McGrail K, Bryan S, Davis J. Let’s all go to the PROM: the case for routine patient-reported outcome measurement in Canadian healthcare. Healthc Pap. 2011;11:8–18.CrossRefPubMed
19.
go back to reference Lopez-Delgado JC, Muñoz-Del Rio G, Flordelís-Lasierra JL, Putzu A. Nutrition in adult cardiac surgery: preoperative evaluation, management in the postoperative period, and clinical implications for outcomes. J Cardiothorac Vasc Anesth. 2019;33:3143–62.CrossRefPubMed Lopez-Delgado JC, Muñoz-Del Rio G, Flordelís-Lasierra JL, Putzu A. Nutrition in adult cardiac surgery: preoperative evaluation, management in the postoperative period, and clinical implications for outcomes. J Cardiothorac Vasc Anesth. 2019;33:3143–62.CrossRefPubMed
20.
go back to reference Knight SR, Qureshi AU, Drake TM, Lapitan MCM, Maimbo M, Yenli E, Tabiri S, Ghosh D, Kingsley PA, Sundar S, Shaw C, Valparaiso AP, Bhangu A, Brocklehurst P, Magill L, Morton DG, Norrie J, Roberts TE, Theodoratou E, Weiser TG, Burden S, Harrison EM. The impact of preoperative oral nutrition supplementation on outcomes in patients undergoing gastrointestinal surgery for cancer in low- and middle-income countries: a systematic review and meta-analysis. Sci Rep. 2022;12:12456.CrossRefPubMedPubMedCentral Knight SR, Qureshi AU, Drake TM, Lapitan MCM, Maimbo M, Yenli E, Tabiri S, Ghosh D, Kingsley PA, Sundar S, Shaw C, Valparaiso AP, Bhangu A, Brocklehurst P, Magill L, Morton DG, Norrie J, Roberts TE, Theodoratou E, Weiser TG, Burden S, Harrison EM. The impact of preoperative oral nutrition supplementation on outcomes in patients undergoing gastrointestinal surgery for cancer in low- and middle-income countries: a systematic review and meta-analysis. Sci Rep. 2022;12:12456.CrossRefPubMedPubMedCentral
21.
go back to reference Gerdessen L, Meybohm P, Choorapoikayil S, Herrmann E, Taeuber I, Neef V, Raimann FJ, Zacharowski K, Piekarski F. Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis. J Clin Monit Comput. 2021;35:245–58.CrossRefPubMed Gerdessen L, Meybohm P, Choorapoikayil S, Herrmann E, Taeuber I, Neef V, Raimann FJ, Zacharowski K, Piekarski F. Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis. J Clin Monit Comput. 2021;35:245–58.CrossRefPubMed
22.
go back to reference Stoppe C, Whitlock R, Arora RC, Heyland DK. Nutrition support in cardiac surgery patients: be calm and feed on! J Thorac Cardiovasc Surg. 2019;158:1103–8.CrossRefPubMed Stoppe C, Whitlock R, Arora RC, Heyland DK. Nutrition support in cardiac surgery patients: be calm and feed on! J Thorac Cardiovasc Surg. 2019;158:1103–8.CrossRefPubMed
Metadata
Title
Effects of preoperative nutritional status on disability-free survival after cardiac and thoracic aortic surgery: a prospective observational study
Authors
Hideaki Kawanishi
Mitsuru Ida
Yusuke Naito
Masahiko Kawaguchi
Publication date
16-03-2023
Publisher
Springer Nature Singapore
Published in
Journal of Anesthesia / Issue 3/2023
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI
https://doi.org/10.1007/s00540-023-03178-4

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