Clinical Value Of Geriatric Nutritional Risk Index For Postoperative Complications In Elderly Patients With Hepatectomy

Objective: To evaluate the clinical value of Geriatric Nutritional Risk Index(GNRI)for predicting complications within 30 days following hepatectomy in elderly patients with hepatic cell carcinoma(HCC).Methods : Clinical data of the elderly(aged ≥65 years)HCC patients admitted to Department of General Surgery(Hepato-pancreatobiliary Surgery Department)from January 2015 to May 2019 were analyzed retrospectively.According to the inclusion and exclusion criteria,a total of 277 elderly HCC patients were included in the study,221 were male patients and 56 were female patients.All elderly patients were divided into two groups depending on whether complications occurred or not,There were 73 cases in the complication group and 204 cases in the non-complication group.Univariate and multivariate logistics regression analysis were performed to address any differences in the preoperative laboratory tests and GNRI between patients with and without complications.Results:1、 Diabetes(OR=2.189,95%CI1.037-4.618,P=0.040),BMI(OR=2.053,95%CI1.253-3.362,P=0.004),ALB(OR=2.132,95%CI1.260-3.606,P=0.005),GNRI(O R=0.665,95%CI0.474-0.933,P=0.018)were independent risk factors for comp lications after hepatectomy in elderly patients with hepatic cell carcinoma.2、 There were statistically significant differences in GNRI values between the postoperative complication group and the non-complication group.The predictive value of GNRI on the severity of postoperative complications after hepatectomy for in elderly patients with HCC: sensitivity 57.7%,specificity 76.2%,the area under curve(AUC)was 0.673,(P=0.021).The critical value of GNRI indistinguishing the severity of complications was 94.36.The length of stay after hepatectomy and hospitalization cost of low GNRI elderly patients(GNRI<94.36)were 14.76(11)days and 54917.90±7146.43 yuan respectively,which were both significantly increased compared with high GNRI elderly patients(GNRI≥94.36)for 12.25(8)days and 47638.35±9061.55 yuan(P=0.001;P=0.001).Conclusion:1、GNRI was an independent risk factor for post-operative complications in elderly patients with HCC after hepatectomy.2、The diabetes,ALB and BMI were independent risk factors for postoperative complications of hepatectomy in elderly patients with hepatectomy.3、The high risk group(GNRI < 82)had a higher incidence of postoperative complications than the moderate risk group(82≤GNRI<92),the low risk group(92≤GNRI<98)and the normal group(GNRI≥98).4、The GNRI can effectively predict the severity of postoperative complications,with a critical value of 94.36.When the GNRI is less than 94.36,the incidence of serious complications after hepatectomy is greatly increased in elderly patients with HCC.Meanwhile,the postoperative hospitalization time is prolonged and the total hospitalization cost is greatly increased.