Preoperative nutrition status and post operative outcome in elderly general surgery patients

Background: Malnutrition, a condition often underdiagnosed and undertreated in older adults, is associated with a spectrum of adverse effects, including impaired immunity, delayed wound healing, increased susceptibility to infections, and prolonged hospitalization. The main purpose of this study is to assess the effect of pre-operative nutritional status on general surgery outcomes of elderly patients in Pakistan. Methods: This is a prospective, cohort study conducted for the duration of 1. Patients aged between 45 – 70 years, both genders, enlisted for general surgery procedure under general anesthesia were requested to enroll in the study, the sample size was estimated at 72, Pre-operative nutritional assessment was evaluated with the help Subjective Global Assessment (SGA) and post-operative assessment was assessed as surgery outcomes morbidity & mortality. Statistical package for social sciences (SPSS) version 23 was used to enter, sort and analyze the data, chi-square test was used to assess significance between two variables keeping p-value of ≤0.05 as significant. Hazard ratio was used to assess risk of complication after surgery in malnourished patients.  Results: Total 72 patients were enrolled in the study; According to SGA, 38 (52.7%) patients were well nourished and 34 (47.2%) patients were malnourished respectively. Morbidity was higher in malnourished patients with overall infection frequency of 7 (9.7%), wound infection was reported in 8 (11.1%), myocardial infarction in 2 (2.7%) and stroke in 1 (1.3%). Mortality was specifically higher in malnourished patients, in hospital mortality was reported in 5 (6.9%) and 30 days after surgery mortality was reported in 4 (5.5%) respectively. Hazard ratio test indicated higher risk of morbidity with HR 2.8 (1.04-3.99), mortality with HR 1.4 (0.81 - 2.24), hospital stay as 1.7 (1.13 - 3.24) and recovery time as 3.81 (1.92 - 5.11) respectively. Conclusion: This study concluded that to avoid post operative complications, prolong hospital stay and mortality proper nutritional assessment is necessary before surgeries for elderly patients, well nourished elderly patients reported less post-operative morbidity and mortality.