Association Between the Preoperative Prognostic Nutritional Index and Postoperative Pulmonary Complications in Gynecological Cancer

Background: The prognostic nutritional index reflects systemic inflammation and nutritional status.This study aimed to evaluate the predicting ability of the preoperative prognostic nutritional index regarding postoperative pulmonary complications in patients with gynecological cancer.Methods: Demographic, laboratory, and clinical data were retrospectively collected from 4,887 patients who underwent gynecological cancer surgery.Preoperative prognostic nutritional indices were calculated from serum albumin levels and total lymphocyte counts.Primary outcome was postoperative pulmonary complications, a composite outcome including acute respiratory distress syndrome, pneumonia, atelectasis, pleural effusion, and pneumothorax within postoperative day 15.Results: In the final analysis, 4,285 were included.An optimal cut-off value of 49.4 for the prognostic nutritional index score was determined using the receiver operating characteristic curve.The study used the stabilized inverse probability of treatment weighting method to reduce bias and compare between the high (n = 2,898.5)and low prognostic nutritional index groups (n = 1,290.4).The incidence of postoperative pulmonary complications is significantly higher in the low prognostic nutritional index group than in the high prognostic nutritional index group (17.0% vs. 8.9%, P < 0.001).In the multivariable logistic regression model after inverse probability of treatment weighting adjustment, a low preoperative prognostic nutritional index was an independent predictor of postoperative pulmonary complications (odds ratio, 1.93; 95% confidence interval, 1.53-2.43;P < 0.001).Conclusion: Low preoperative prognostic nutritional indices are associated with postoperative pulmonary complications in patients undergoing surgery for gynecologic cancer.