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Introduction <p>Preoperative nutritional status is critical in perioperative outcomes for patients undergoing pancreaticoduodenectomy (PD). Malnutrition has been linked to increased postoperative complications, prolonged hospitalization, and higher mortality rates. This study aims to evaluate the impact of Geriatric Nutritional Risk Index (GNRI) on short-term surgical outcomes, ICU-related variables, and hospital costs in PD patients.</p> Methods <p>This retrospective cohort study utilized the Chang Gung Research Database (CGRD) to analyze patients who underwent PD between 2014 and 2023. GNRI was calculated based on preoperative albumin levels and body mass index, categorizing patients into low (GNRI &lt; 82), moderate (82 ≤ GNRI &lt; 98), and high (GNRI &gt; 98) GNRI groups. The primary outcomes included 30-day mortality and major postoperative complications. Secondary outcomes encompassed ICU-related factors and a cost analysis. Statistical analyses were performed using multivariable logistic regression to adjust for confounders.</p> Results <p>A total of 1203 patients were analyzed, with 67 in the low GNRI group, 544 in the moderate GNRI group, and 592 in the high GNRI group. Patients with GNRI &lt; 82 had significantly higher 30-day (14.93%) and 90-day mortality (26.87%) compared to other groups (<i>p</i> &lt; 0.0001). Major complications (29.85%) and reoperation rates (20.9%) were also markedly elevated (<i>p</i> &lt; 0.0001). In multivariable analysis, patients in low GNRI group had a higher likelihood of prolonged ICU stay (adjusted OR 3.98, <i>p</i> &lt; 0.0001), extended ventilator use (adjusted OR 2.97, <i>p</i> = 0.002), increased reintubation rates, and higher ICU readmission rates (both <i>p</i> &lt; 0.0001). In addition, these patients exhibited substantially greater total hospital, ICU, and ventilator costs (all <i>p</i> &lt; 0.0001).</p> Conclusion <p>Preoperative GNRI serves as a strong predictor of postoperative outcomes in PD. Patients with GNRI &lt; 82 faced significantly higher mortality, major complications, prolonged ICU stays, and increased healthcare costs. Given their heightened risk of early mortality and extended hospital cost, these patients should receive aggressive preoperative nutritional intervention and comprehensive perioperative management to optimize surgical outcomes.</p>

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Predictive value of the geriatric nutritional risk index for postoperative outcomes and healthcare costs in patients undergoing pancreaticoduodenectomy

  • 期刊论文

  • 发表日期：

    2025年10月14日

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  • Szu-Wei Huang,
  • Ming‑Chun Kuo,
  • Teng-Yuan Hou,
  • Fai-Meng Sou,
  • Na-Ning Kan,
  • Chang-Ting Lin,
  • Shih-Min Yin

摘要

Introduction

Preoperative nutritional status is critical in perioperative outcomes for patients undergoing pancreaticoduodenectomy (PD). Malnutrition has been linked to increased postoperative complications, prolonged hospitalization, and higher mortality rates. This study aims to evaluate the impact of Geriatric Nutritional Risk Index (GNRI) on short-term surgical outcomes, ICU-related variables, and hospital costs in PD patients.

Methods

This retrospective cohort study utilized the Chang Gung Research Database (CGRD) to analyze patients who underwent PD between 2014 and 2023. GNRI was calculated based on preoperative albumin levels and body mass index, categorizing patients into low (GNRI < 82), moderate (82 ≤ GNRI < 98), and high (GNRI > 98) GNRI groups. The primary outcomes included 30-day mortality and major postoperative complications. Secondary outcomes encompassed ICU-related factors and a cost analysis. Statistical analyses were performed using multivariable logistic regression to adjust for confounders.

Results

A total of 1203 patients were analyzed, with 67 in the low GNRI group, 544 in the moderate GNRI group, and 592 in the high GNRI group. Patients with GNRI < 82 had significantly higher 30-day (14.93%) and 90-day mortality (26.87%) compared to other groups (p < 0.0001). Major complications (29.85%) and reoperation rates (20.9%) were also markedly elevated (p < 0.0001). In multivariable analysis, patients in low GNRI group had a higher likelihood of prolonged ICU stay (adjusted OR 3.98, p < 0.0001), extended ventilator use (adjusted OR 2.97, p = 0.002), increased reintubation rates, and higher ICU readmission rates (both p < 0.0001). In addition, these patients exhibited substantially greater total hospital, ICU, and ventilator costs (all p < 0.0001).

Conclusion

Preoperative GNRI serves as a strong predictor of postoperative outcomes in PD. Patients with GNRI < 82 faced significantly higher mortality, major complications, prolonged ICU stays, and increased healthcare costs. Given their heightened risk of early mortality and extended hospital cost, these patients should receive aggressive preoperative nutritional intervention and comprehensive perioperative management to optimize surgical outcomes.