Nutritional risk assessment in patient undergoing major gastrointestinal surgeries

Introduction: Malnutrition is prevalent in surgical patients in the range of 20-50%, depending on the population studied and method employed to determine nutritional status. Malnutrition is associated with adverse clinical outcomes, slow healing, increase in infection and longer hospital stay. There are several methods to assess the nutritional status of surgical patients. However, none has been universally accepted and there is no consensus on the best system. The Nutritional Risk Screening score (NRS 2002) was developed based on the presupposition that the severity of malnutrition indicates increased nutritional requirements and need for nutritional support. It has received approval from the European Society for Parenteral and Enteral Nutrition for use in the hospital setting. It is easy to administer in daily clinical practice and offers satisfactory reliability and reproducibility. The aim of the present study was to identify nutritional risk in patients undergoing major gastrointestinal surgeries using NRS2002 and to determine possible associations with postoperative complications. Methods: This is a prospective study carried out in department of surgery, Nepal Medical College and Teaching Hospital from 1st August 2016 to 30th July 2017. All the major gastrointestinal surgeries performed during this period were included. The nutritional assessment was done by BMI, Serum protein albumin and nutritional risk screening score (NRS 2002). Results: Sixty three patients who underwent major gastrointestinal surgery were included in this study: Sixty percent patients (n - 38) were male, 68.8% had BMI within ideal range (18.5 - 25.9kg / m2), 71.4% (n=45) patients underwent elective surgery and 68.2% (n =43) had malignancy. A total of 44.4% (n =28) of the patients were classified as being "at nutritional risk" and 47.6% (n=30) had postoperative complications. The mean NRS score was significantly higher among the patients who had complications compared to those who did not have complication (3.7 ±1.2 vs 3 ± 1, p = 0.016). Low serum albumin, BMI and absolute lymphocyte count correlated with presence of nutritional risk assessed by NRS 2002 and complications. Conclusions: NRS 2002 is simple and easy to apply in routine clinical practice for nutritional assessment. It correlates with postoperative complications. Serum albumin, BMI and absolute lymphocyte count are also simple tools for nutritional assessment of surgical patients and can be used in supplementation with NRS 2002 for better accuracy.