Nutritional risk index as a predictor of postoperative wound complications after gastrectomy

Table 1 Types and definitions of wound complications

Types	Definitions
Seroma	Serous fluid collection in the absence of infection
Hematoma	Subcutaneous blood in the absence of infection
Wound infection	Displayed two or more of the following characteristics: drainage of purulent material, erythema, tenderness, induration or fever
Wound dehiscence	(1) Hematoma, seroma, or infection that required that the incision be opened, evacuated, and/or irrigated and debrided;
	(2) Status that required packing and healing by secondary intention

From Chelmow et al[9] 2004.

Table 2 Characteristics of patients according to the nutritional risk index on the 5th postoperative day

Characteristic		NRI			P value
		< 97.5	≥97.5	All
		(n = 566, 84.6%)	(n = 103, 15.4%)	(n = 669)
Gender, n (%)	Male	346 (61)	86 (83)	432	0.0001
	Female	220 (39)	17 (17)	237
Age, mean ± SD		57.15 ± 11.7	54.70 ± 9.69	56.77 ± 11.44	0.0352
Disease progression, n (%)	EGC	307 (54)	72 (70)	379	0.0031
	AGC	259 (46)	31 (30)	290
Type of operation, n (%)	B-I	355 (63)	89 (86.4)	444	0.0001
	B-II	61 (11)	5 (4.9)	66
	TG	150 (26)	9 (8.7)	159
Comorbid diseases, n (%)	Hypertension	130 (23)	29 (28.1)	159	0.3651
	Diabetes mellitus	66 (11.7)	20 (19.4)	86
	Pulmonary tuberculosis	22 (3.9)	7 (6.8)	29
	Cardiovascular diseases	13 (2.3)	3 (2.9)	16
	Hepatitis	40 (7.1)	5 (4.8)	45
	Others	18 (3)	1 (1)	19
	None	277 (50)	38 (36.9)	315
Postoperative hospital stay (d, mean ± SD)		12.76 ± 4.02	12.01 ± 2.45	12.64 ± 3.82	0.1602
Postoperative wound complication, n (%)		62 (10.9)	4 (3.8)	66 (9.86)	0.0271

NRI: Nutrition risk index; EGC: Early gastric cancer; AGC: Advanced gastric cancer; B-I: Subtotal gastrectomy with Billroth–Ireconstruction; B-II: Subtotal gastrectomy with Billroth–II reconstruction; TG: Total gastrectomy.

¹Fisher’s exact test;

²Mann-Whitney U test.

Table 3 Relationship between patient characteristics and occurrence of wound complications

Characteristic		Wound complication			P value
		(-)	(+)	All
		(n = 603)	(n = 66)	(n = 669)
Gender, n (%)	Male	393 (65.2)	39 (59.1)	432	0.3271
	Female	210 (34.8)	27 (40.9)	237
Age, mean ± SD		56.57 ± 11.2	58.62 ± 13.2	56.77 ± 11.44	0.1642
Disease progression, n (%)	EGC	346 (57.4)	33 (50)	379	0.2511
	AGC	257 (42.6)	33 (50)	290
Type of operation, n (%)	B-I	404 (67)	40 (60.6)	444	0.2531
	B-II	61 (10)	5 (7.6)	66
	TG	138 (23)	21 (31.8)	159
Comorbid diseases, n (%)	Hypertension	142 (23.5)	17 (25.8)	159	0.7221
	Diabetes mellitus	73 (12.1)	20 (30.3)	93
	Pulmonary tuberculosis	26 (4.3)	7 (10.6)	33
	Cardiovascular diseases	16 (2.7)	0 (0)	16
	Hepatitis	40 (6.6)	5 (7.6)	45
	Others	17 (2.8)	2 (3)	19
	None	289 (48)	15 (22.7)	304
Postoperative hospital stay (d, mean ± SD)		12.24 ± 3.25	16.38 ± 6.104	12.64 ± 3.82	0.0002
NRI, n (%)	NRI < 97.5	504 (83.6)	62 (93.9)	566	0.0271
	NRI ≥ 97.5	99 (16.4)	4 (6.1)	103

NRI: Nutrition risk index; EGC: Early gastric cancer; AGC: Advanced gastric cancer; B-I: Subtotal gastrectomy with Billroth–Ireconstruction; B-II: Subtotal gastrectomy with Billroth–II reconstruction; TG: Total gastrectomy.

¹Fisher’s exact test;

²Mann-Whitney U test.

Table 4 Distribution of types of wound complications according to the nutritional risk index

	NRI
	< 97.5n = 62	≥97.5n = 4
Seroma	36	0
Hematoma	4	0
Wound infection	9	0
Wound dehiscence	13	4
Total	62	4

NRI: Nutrition risk index.

Table 5 Multivariate analysis of characteristics of patients with wound complications by logistical regression

	Odds ratio (95% CI)	P value
Age (≥ 56.77 vs < 56.77)	1.299 (0.829-2.035)	0.253
Gender (male vs female)	1.253 (0.795-1.976)	0.330
Disease progression (AGC vs EGC)	1.363 (0.873-2.127)	0.157
Surgical methods:		0.400
B-II vs B-I	0.839 (0.365-1.930)	0.679
TG vs B-I	1.511 (0.920-2.483)	0.103
Comorbid diseases		NS
NRI ( ≥ 97.5 vs < 97.5)	0.653 (0.326-0.974)	0.014

NRI: Nutrition risk index; EGC: Early gastric cancer; AGC: Advanced gastric cancer; B-I: Subtotal gastrectomy with Billroth–Ireconstruction; B-II: Subtotal gastrectomy with Billroth–II reconstruction; TG: Total gastrectomy; NS: Not significant; CI: Confidence interval.