Preoperative @entity2313 and surgical site identify surgical risk for major XXXX .

@entity1 @entity2313 @entity4988 @entity260 @entity3147
BACKGROUND: Although @entity3147 contributes to morbidity, studies of pre- and postoperative nutrition often include well-nourished @entity1 unlikely to benefit from therapy and usually do not stratify by the site of surgical pathology. This study evaluates whether perceived preoperative markers of nutritional status recorded in charts correlates with @entity260 and resource use in @entity1 who receive no preoperative nutrition support and reinterprets the results of several conflicting randomized, prospective studies in this context. METHODS: This is a retrospective cohort study of 526 surgical @entity1 who had preoperative serum @entity2313 levels measured and were undergoing elective esophageal, gastric, pancreaticoduodenal, or colon surgery between 1992 and 1996 who could have received preoperative nutrition but did not. RESULTS: Most medical records contained inadequate analysis of preoperative nutritional status, but preoperative @entity2313 correlated inversely with complications, length of stay, postoperative stay, intensive care unit (ICU) stay, mortality, and resumption of oral intake. @entity1 undergoing esophageal or pancreatic procedures sustained a significantly higher complication rate at most @entity2313 levels, whereas colonic surgery resulted in lower complication rates at the same @entity2313 levels. Resource use (eg, length of stay and ICU stay) related to these complication rates; esophageal and pancreatic procedures used the most resources and colon procedures used the fewest at most @entity2313 levels. This lack of appreciation for nutritional risk and operative site can explain discrepancies in outcome noted in several randomized, prospective nutritional studies and must be applied to the design and implementation of new studies. CONCLUSIONS: Elective, non-emergent esophageal and pancreatic procedures performed in @entity1 who could have had surgery delayed for preoperative nutrition, but did not, result in higher risk than colon surgery at any given level of serum @entity2313 below 3.25 g/dL. @entity1 populations in trials should be stratified by operative site and by markers of nutritional status. Degree of @entity4988 and other potential markers of nutritional status may explain many of the discrepancies between trials of nutrition support. Preexisting @entity4988 in @entity1 undergoing elective surgery remains underappreciated, unrecognized, and untreated in many hospitalized @entity1 .
