THE PREOPERATIVE NUTRITIONAL ASSESSMENT OF SURGICAL PATIENTS WITH HEPATIC-DYSFUNCTION

The precise influence of malnutrition on postoperative complications i n patients with hepatic dysfunction is not well known. In phase I of t he present study, we evaluated the nutritional status of 102 patients with hepatic dysfunction who were admitted for elective hepatobiliary or pancreatic surgery, and a model for the prediction of postoperative complications was developed using a computer-based stepwise regressio n procedure. The equation for this Prognostic Nutritional Index for Su rgery (PNIS) was calculated by [-0.147 x (% weight change) + 0.046 x ( % ideal body weight) + 0.010 x (actual triceps skinfold thickness as a % of standard value) + 0.051 x (hepaplastintest)]. In phase II this m odel was prospectively tested in 182 patients, including 145 with hepa tic dysfunction. A total of 18 patients were classified as having a po or prognosis (PNIS < 5) and all of these patients in fact developed po stoperative complications: 128 patients were classified as having an i ntermediate prognosis (5 less than or equal to PNIS < 10), 23 (18.0%) of whom developed postoperative complications, and none of the 36 pati ents who were classified as having a good prognosis (PNIS greater than or equal to 10) developed any postoperative complications. These resu lts demonstrate the importance of performing a thorough preoperative n utritional assessment of patients with hepatic dysfunction as malnouri shed patients with PNIS < 10 may need preoperative nutritional managem ent, even when their surgical procedures are not major.