Predicting Morbidity in Pancreaticoduodenectomy: A Focus on Nutritional Status

Background and aim Pancreaticoduodenectomy (Whipple procedure) remains associated with high postoperative morbidity, including surgical site infections (SSIs) and pancreatic fistulas, despite advances in surgical care. Although the role of nutrition in pancreatic surgery is increasingly recognized, prospective data evaluating multiple nutritional indices in predicting postoperative morbidity remain limited. This study investigates the association between preoperative nutritional status and postoperative complications following pancreaticoduodenectomy. Methods A prospective observational study enrolled 164 patients undergoing pancreaticoduodenectomy at a tertiary care institute in the Jammu and Kashmir region of India from January 2020 to December 2024. Nutritional status was assessed preoperatively using serum albumin levels, the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), and the percentage of weight loss. Primary outcomes were SSI incidence (per the CDC criteria) and pancreatic fistula grade (per the International Study Group on Pancreatic Surgery 2016). Univariate and multivariate logistic regression analyses identified predictors, with propensity score matching to address bias; p < 0.05 was considered significant. Results Patients had a mean age of 55 years (range: 32-78), with 55% male and 97.6% of cases being malignant (84.8% adenocarcinoma). Univariate analysis showed significant associations (all p < 0.001) between poor nutritional parameters, such as severe hypoalbuminemia (<2.5 g/dL), high MUST/NRI scores, and >5% weight loss, and increased SSI/pancreatic fistula rates. Multivariate analysis confirmed these as independent risk factors. Conclusions Preoperative malnutrition strongly predicts postoperative SSIs and pancreatic fistulas after pancreaticoduodenectomy. Routine nutritional screening with MUST, NRI, albumin, and weight loss assessment, followed by prehabilitation, can optimize outcomes in this high-risk population.