A31-23 Preoperative Prognostic Nutritional Index Stratifies Risk and Predicts Outcomes After Robotic-assisted Pulmonary Lobectomy

Rationale Prognostic nutritional index (PNI) has proven utility in the field of thoracic oncology with demonstrated predictive capability for both short- and long-term outcomes following surgical intervention. However, there is a lack of consensus in the field for a benchmark value to denote high-risk patients and allow alternative management. This analysis attempts to establish the correlation between outcomes following robotic-assisted video-thoracoscopic (RAVTS) lobectomy in low PNI patients. Methods A retrospective cohort analysis was conducted for patients who underwent RAVTS lobectomy from 2010-2025 by one surgeon. Preoperative PNI was calculated for patients using the following equation PNI = (10*albumin g/dL) + (0.005*total lymphocyte count /mm3). Patients were then stratified into two categories based on a benchmark of 50: Low PNI (<50) and Normal PNI (≥50). Outcomes assessed included intraoperative complications, intraoperative estimated blood loss (EBL), skin-to-skin operative time, postoperative complications, chest tube duration, hospital length of stay (LOS), 30-day mortality, and median operative survival (OS) time (MST). Mann-Whitney U, Chi square, Kaplan-Meier, and binary logistic regression were utilized appropriately. Statistical analysis was performed using SPSS version 30. Results Of 859 total patients, 615 evaluable patients (mean age 68.7 years; mean BMI 27.8 kg/m2) were included, with 411 having Normal PNI and 204 having Low PNI. Low PNI was significantly associated with increased EBL (median [Q1,Q3] 100 mL [50, 263] vs.100 mL [50, 150]; p < 0.001) and increased skin-to-skin duration (179 min [148, 225] vs. 169 min [142, 203]; p = 0.008), but Low PNI was not significantly associated with increased intraoperative complications (6.8% vs. 3.6%; p = 0.079). Low PNI was significantly associated with increased LOS (mean 6±0.3 days vs 5±0.2 days; median [Q1,Q3] 4 days [3, 7] vs 4 days [3, 6]; p = 0.005) and increased 30-day mortality (3.4% vs. 0.5%; p = 0.032), Low PNI was not significantly associated with increased post operative complications (41.5% vs. 38.2%; p = 0.429) or increased chest tube duration (median [Q1,Q3] 4 days [2, 6] vs. 3 days [2, 6]; p = 0.134). On Kaplan-Meier analysis, PNI was associated with reduced MST (76.2 months [95%CI=54.7-97.8] vs. 91.0 months [95%CI=77.0-104.9]) and 5-year OS rates (86.0% vs. 97.4%) (log-rank p = 0.001). Conclusion Preoperative PNI demonstrates predictive value for significant patient outcomes and healthcare burden following RAVTS lobectomy in our patient population with a benchmark of 50. Further investigation with randomized controlled trials, larger cohorts, and multi-institutional collaboration is necessary to understand precipitating factors leading to worse outcomes in Low PNI patients and to inform clinical assessment, patient counseling, and decision-making. This abstract is funded by: None