scholarly journals O19 The effect of malnutrition on early outcomes after elective cancer surgery: an international prospective cohort study in 82 countries

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
Aya M Riad ◽  
Stephen R Knight ◽  
M Ewen ◽  
Keyword(s):  
Gastric Cancer ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Elective Surgery ◽  
Cancer Surgery ◽  
Postoperative Outcomes ◽  
Severe Malnutrition ◽  
Middle Income ◽  
Middle Income Countries

Abstract Introduction Malnutrition is a key priority on the global health agenda, yet the impact of nutritional state on cancer surgery across income strata remains poorly described. This study aimed to determine the effect of malnutrition on early postoperative outcomes following elective surgery for colorectal or gastric cancer. Method Multicentre, international prospective cohort study of consecutive patients undergoing elective surgery for colorectal or gastric cancer. Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression and three-way mediation analysis determined the relationship between country income group, nutritional status and early postoperative outcomes. Result This study included 5709 patients (4593 colorectal; 1116 gastric) from 381 hospitals in 75 countries. Severe malnutrition was present in one third of patients, with a disproportionate burden in upper middle (44%) and low/lower-middle income countries (64%). After adjustment for patient and hospital risk factors, severe malnutrition (aOR 1.62, 95% confidence interval 1.07 to 2.48; P = 0.024) was an independent predictor of 30-day mortality. However, major postoperative complications and surgical site infection rates were similar. Conclusion Severe malnutrition represents a high global burden in cancer surgery, particularly within low-income settings. Malnutrition is an independent risk-factor for 30-day mortality following elective surgery for colorectal or gastric cancer, suggesting perioperative nutritional interventions may improve early outcomes following cancer surgery. Take-home Message Severe malnutrition affects a large proportion of elective surgical oncology patients, with a significantly higher burden in low and middle income countries. Severe malnutrition is independently associated with increased 30-day mortality after cancer surgery.

scholarly journals 427 The Effect of Malnutrition on Early Outcomes after Cancer Surgery: An International Prospective Cohort Study in 82 Countries

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Riad ◽  
S Knight ◽  
E Harrison
Keyword(s):  
Colorectal Cancer ◽  
Cohort Study ◽  
Elective Surgery ◽  
Final Analysis ◽  
Cancer Surgery ◽  
Postoperative Outcomes ◽  
Disease Stage ◽  
Severe Malnutrition ◽  
Colorectal Cancer Surgery ◽  
After Cancer

Abstract Background Malnutrition is a state linked to worse postoperative outcomes, and cancer patients are particularly vulnerable due to cachexia. We aimed to explore the effect of malnutrition on 30-day mortality following gastric and colorectal cancer surgery. Method GlobalSurg3 was multicentre international cohort study which collected data from consecutive patients undergoing emergency or elective surgery for gastric and colorectal cancer. Malnutrition was defined using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Multilevel variable regression approaches determined the relationship between malnutrition and early postoperative outcomes. Results 6438 patients were included in the final analysis (1184 gastric cancer; 5254 colorectal cancer). Severe malnutrition was common across all income-strata, affecting 1 in 4 patients overall, with a higher burden in low and lower-middle income countries (64%). In patients undergoing elective surgery (n = 5709), severe malnutrition was independently associated with increased mortality (aOR = 1.62 (1.07-2.48, P = 0.024) after accounting for patient factors, disease stage and country effects. Conclusions Severe malnutrition represents a high global burden in cancer surgery, particularly within lower income settings. Malnutrition is an independent risk-factor for 30-day mortality following elective surgery for gastric and colorectal cancer, suggesting perioperative nutritional interventions may improve outcomes after cancer surgery.

scholarly journals Supplemental oxygen in Queen Elizabeth Central Hospital Malawi: a prospective cohort study of patients admitted to medical wards

2021 ◽  
Vol 6 ◽  
pp. 29
Author(s):  
Helen Thomson ◽  
Maness Mlaviwa ◽  
Jamie Rylance ◽  
Hannah Jones ◽  
Ammoah Reuben ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Chest Radiograph ◽  
Prospective Cohort ◽  
Oxygen Therapy ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
Risk Of Death ◽  
Medical Wards

Background: Oxygen is designated an essential drug by the World Health Organisation, and reduces mortality in hypoxic patients. In low-resource settings the provision of oxygen seldom meets its demand. This study explores predictors and observed time-course of hypoxaemia in order to help inform needs assessments for oxygen in hospitals in low- and middle-income countries. Methods: A prospective cohort study of adults with hypoxaemia admitted to medical wards of a teaching hospital in Malawi between February and March 2020. Vital signs and oxygen therapy were recorded daily. We analysed outcomes (death, discharge from hospital or ongoing inpatient care at 14 days after admission) using Kaplan-Meier and Cox regression time-to-event analysis. Results: 33 patients were recruited with median age 45 years (IQR 33-61). 13 (39%) were female. Median pre-treatment oxygen saturations were 84% (IQR 76-87%). Oxygen delivery devices were often shared with other patients (n=10, 33%) and the flow rate was often unknown (n=14, 47%), mostly because of broken equipment (n=8, 57%). Median duration of oxygen therapy was 3 days (IQR 1-7). Death occurred in 16 (49%). Hazard ratios for short oxygen therapy were reduced in patients who had a chest radiograph performed (HR 0.08, 95% CI 0.02–0.30), in ex-smokers (HR 0.01, 95% CI 0.00-0.22) and in never smokers (HR 0.03, 95% CI 0.00 – 0.78). Conclusions: Delivering oxygen therapy in lower-middle income countries is challenging; broken equipment and shared delivery devices prevented titration of flow rates. Patients were relatively young and at a high risk of death. Patients with a chest radiograph received oxygen for longer than those without. This hypothesis generating study can be used to build a more comprehensive understanding of oxygen supply need at the hospital level.

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