Effect of Malnutrition Assessed by Comprehensive Nutritional Screening Tool on In-Hospital Mortality after Surgery for Gastrointestinal Perforation

Purpose: This study examined the effects of malnutrition on in-hospital mortality after surgery for gastrointestinal (GI) perforation. Materials and Methods: Patients who underwent surgery for GI perforation between 2010 and 2017 were analyzed retrospectively. The preoperative nutritional status was assessed by the Seoul National University Hospital-Nutrition Screening Index, a tool that comprehensively evaluates 11 factors that reflect the nutritional status. The risk factors for in-hospital mortality after surgery for GI perforation were evaluated by univariate and multivariate analyses. Results: Four hundred and eighty-nine patients were divided into two groups: 439 patients in the survival group and 50 patients in the in-hospital mortality group. The risk of malnutrition was higher (93.6% vs. 65.9%, P<0.001) in the in-hospital mortality group than in the survival group. The preoperative albumin level was lower, and the blood urea nitrogen level was higher in the in-hospital mortality group than in the survival group. Emergency surgery, lymphoma as a cause of perforation, and fecal-contaminated ascites were also identified as factors associated with in-hospital mortality. Multivariate analyses demonstrated that a high risk of malnutrition (HR=5.71, 95% CI 1.38~26.02, P=0.017), lymphoma as a cause of perforation (HR=4.12, 95% CI 1.17~14.51, P=0.028), low preoperative albumin (HR=4.77, 95% CI 2.35~9.69, P<0.001), and high preoperative BUN (HR=1.03, 95% CI 1.01~1.05, P=0.001) had significant effects on the in-hospital mortality after surgery for GI perforation.