Clinical significance of preoperative nutritional status in elderly gastric cancer patients undergoing radical gastrectomy: A single-center retrospective study

Table 1 Clinical characteristics of malnourished and well-nourished elderly patients

Factor	Malnourished		Well-nourished		P value	Total
All patients	249	100	534	100		783	100
Age (years)					< 0.001
Median (IQR)	72 (69, 76)		69 (67, 73)			70 (67, 74)
Gender					0.762
Female	65	26.1	134	25.1		199	25.4
Male	184	73.9	400	74.9		584	74.6
Comorbidity					0.321
0-2	221	88.8	486	91.0		707	90.3
≥ 3	28	11.2	48	9.0		76	9.7
Type of anesthesia					0.073
GA	35	14.1	52	9.7		87	11.1
TEA	214	85.9	482	90.3		696	88.9
Type of surgery					0.721
Total gastrectomy	112	45.0	247	46.3		359	45.8
Distal gastrectomy	130	52.2	267	50.0		397	50.7
Proximal gastrectomy	7	2.8	20	3.7		27	3.5
Operation time (min)					0.082
Median (IQR)	160 (126, 189)		160 (129, 191)			160 (123, 189)
Preoperative consultation					0.303
No	202	81.1	449	84.1		651	83.1
Yes	47	18.9	85	15.9		132	16.9
Neoadjuvant chemotherapy					0.647
No	240	96.4	518	97.0		758	96.8
Yes	9	3.6	16	3.0		25	3.2
TNM stage					0.059
I	32	12.9	87	16.3		126	16.1
II	53	21.3	133	24.9		150	19.2
III	164	65.8	314	58.8		507	64.7
Clavien-Dindo classification					< 0.001
None	193	77.5	476	89.1		669	85.4
I + II	27	10.8	37	6.9		64	8.2
III or higher	29	11.7	21	4.0		50	6.4
Cost of hospitalization (× 103 RMB)					0.293
Median (IQR)	55.3 (47.4, 66.6)		54.7 (47.8, 63.2)			54.8 (47.7, 64.7)
Re-admission within 30 days	11	4.4	4	0.7	0.790	15	1.9

GA: General anesthesia; TEA: General anesthesia combined with thoracic epidural block; IQR: Interquartile range.

Table 2 Nutritional characteristics of malnourished and well-nourished elderly gastric cancer patients

Factor	Malnourished	Well-nourished	P value	Total
BMI (kg/m2)	19.4 ±1.8	24.5 ± 2.6	< 0.001	22.9 ± 3.4
PNI	46.7 ± 5.7	48.8 ± 5.3	< 0.001	48.1 ± 5.6
Albumin (g/L)	39.1 ± 4.6	40.7 ± 4.0	< 0.001	40.2 ± 4.3
Prealbumin (mg/L)	193.2 ± 50.6	214.6 ± 47.7	< 0.001	207.8 ± 49.6
Hemoglobin (g/L)	117.0 ± 24.1	122.8 ± 23.1	0.001	121.0 ± 23.6
TLC (× 109/L)	1.57 ± 0.55	1.60 ± 0.54	0.472	1.59 ± 0.54

BMI: Body mass index; PNI: Prognostic nutritional index; TLC: Total lymphocyte count.

Table 3 Perioperative nutritional support among elderly gastric cancer patients

Factor	Malnourished		Well-nourished		P value	Total
Preoperative nutrition					< 0.001
Diet	141	56.6	218	40.8		359	45.9
Diet + single transfusion	77	30.8	295	55.4		373	47.6
TPN	31	12.4	20	3.7		51	6.5
Postoperative nutrition					0.001
Single transfusion	194	77.9	355	66.5		549	70.1
TNA	55	22.1	179	33.5		234	29.9
Postoperative PN period (days)					0.951
Median (IQR)	5 (4, 6)		5 (4, 6)			5 (4, 6)
Postoperative EN period (days)					0.273
Median (IQR)	2 (1, 3)		2 (1, 2)			2 (1, 2)

EN: Enteral nutrition; PN: Parenteral nutrition; TPN: Total parenteral nutrition; TNA: Total nutrient admixture; IQR: Interquartile range.

Table 4 Univariate Cox regression analyses of clinical factors associated with length of stay

Factor	LOS (days)	Hazard ratio (95%CI)	P value
Age (years)1			0.002
< 70	7 (7, 9)	1.000 (reference)
≥ 70	8 (7, 10)	1.620 (1.110-2.364)
Gender			0.076
Female	7 (7, 9)	1.000 (reference)
Male	8 (7, 10)	0.866 (0.568-1.319)
Nutritional status			0.134
Well-nourished	8 (7, 9)	1.000 (reference)
Malnourished	8 (7, 10)	0.652 (0.361-1.178)
Operation time (min)1			< 0.001
< 160	7 (7, 8)	1.000 (reference)
≥ 160	8 (7, 11)	2.307 (1.600-3.328)
Type of anesthesia			0.099
GA	8 (7, 11)	1.000 (reference)
TEA	8 (7, 9)	0.732 (0.432-1.238)
Type of surgery			0.055
Distal gastrectomy	7 (7, 9)	1.000 (reference)
Proximal gastrectomy	8 (7, 9)	0.611 (0.422-0.887)
Total gastrectomy	8 (7, 10)	0.510 (0.173-1.500)
Comorbidity			0.038
0-2	8 (7, 9)	1.000 (reference)
≥ 3	8 (7, 11)	2.415 (1.819-3.411)
BMI			0.088
≥ 20	8 (7, 10)	1.000 (reference)
< 20	8 (7, 9)	0.565 (0.294-1.089)
PNI1			0.005
≥ 44.5	8 (7, 11)	1.000 (reference)
< 44.5	10 (7, 11)	3.940 (1.042-7.904)
Albumin (g/L)			0.107
≥ 30	8 (7, 9)	1.000 (reference)
< 30	9 (8, 13)	1.087 (0.734-1.610)
Prealbumin (mg/L)			0.046
≥ 180	8 (7, 9)	1.000 (reference)
< 180	8 (7, 10)	1.265 (1.133-1.919)
Hemoglobin (g/L)			0.169
≥ 90	8 (7, 9)	1.000 (reference)
< 90	8 (7, 11)	1.418 (0.852-2.360)
Postoperative nutrition			0.337
Single transfusion	8 (7, 10)	1.000 (reference)
TNA	8 (7, 9)	0.826 (0.558-1.221)
Clavien-Dindo classification			< 0.001
None	8 (7, 9)	1.000 (reference)
I + II	10 (7, 12)	4.161 (2.199-7.876)
III or higher	10 (7, 17)	4.843 (2.771-8.464)

¹Split at median.

LOS: Length of stay; GA: General anesthesia; TEA: General anesthesia combined with thoracic epidural block; BMI: Body mass index; PNI: Prognostic nutritional index; TNA: Total nutrient admixture.

Table 5 Multivariate Cox regression analyses of clinical factors associated with length of stay

Factor	LOS (days)	Hazard ratio (95%CI)	P value
Age (years)1
< 70	7 (7, 9)	1.000 (reference)
≥ 70	8 (7, 10)	1.216 (1.048-1.411)	0.010
Operation time (min)1
< 160	7 (7, 8)	1.000 (reference)
≥ 160	8 (7, 11)	1.431 (1.237-1.656)	< 0.001
Comorbidity
0-2	8 (7, 9)	1.000 (reference)
≥ 3	8 (7, 11)	1.067 (0.839-1.357)	0.595
PNI1
≥ 44.5	8 (7, 11)	1.000 (reference)
< 44.5	9 (8, 13)	1.792 (1.058-3.032)	0.030
Prealbumin (mg/L)
≥ 180	8 (7, 9)	1.000 (reference)
< 180	8 (7, 10)	0.797 (0.514-1.237)	0.312
Clavien-Dindo classification
None	8 (7, 9)	1.000 (reference)
I + II	10 (7, 12)	1.163 (1.163-1.701)	0.435
III or higher	10 (7, 17)	2.191 (1.604-2.991)	< 0.001

¹Split at median.

LOS: Length of stay; PNI: Prognostic nutritional index.