Análisis de los factores relacionados con las complicaciones y de la capacidad predictiva de los test de cribado nutricional en cirugía mayor abdominal

Abstract

Objectives Major abdominal surgery is a process that involves a high percentage of postsurgical complications (10-40%) with different levels of severity. The objectives of our work are the following: 1. Analysis of complications associated with patients undergoing major abdominal surgery. 2. Identify the factors that are related to the appearance of complications in major abdominal surgery. 3. Compare the predictive capacity of the nutritional risk tests related to surgical complications in major abdominal surgery. 4. Analyze the interobserver agreement of the different nutritional screening tests. 5. Study the feasibility and time in carrying out the different screening tests. Methodology The study was carried out at the Hospital General Universitario José María Morales Meseguer in Murcia, which serves a population of 520,000 inhabitants. The study methodology is twofold and is in relation to the objectives set. • Part I: Retrospective analytical observational study carried out between July 2012 and December 2013. 255 patients were selected consecutively, who underwent scheduled major abdominal surgery (colorectal surgery, bariatric, gastric and cystectomies). The information was collected from the SELENE computer system and the usual medical history. Postoperative complications were classified according to the Clavien-Dindo scale. The groups to be analyzed were divided according to the Clavien-Dindo grade. • Part II: It is a prospective analytical observational study conducted between January and June 2016. 103 consecutive patients were selected, who underwent scheduled major abdominal surgery (colorecta surgeryl, bariatric, gastric and cystectomies). An interview was conducted 24 hours prior to surgery in which the information from the main nutritional screening tests (MST, SNAQ, FILNUT, MUST, NRS 2002, PG-SGA and MNA-SF) was collected. The groups to be analyzed were divided according to the Clavien-Dindo grade. The statistical analysis was performed using the IBM SPSS version 22.0 software for Windows. Conclusions 1. In our series of patients, 39.2% did not suffer any postoperative complication and 60.8% presented some complication. 40.4% had a Clavien-Dindo complication > I. 2. Age, body mass index, albumin and hemoglobin, as well as late onset of oral tolerance are associated with a higher rate of Clavien-Dindo > I complications. 3. The presence of EPOC, gastric surgery, and preoperative hemoglobin are independent predictors of postoperative Clavien-Dindo > I complications in major abdominal surgery. 4. All the nutritional screening tests showed significant differences regarding the test result and the severity of postoperative complications. 5. The NRS 2002 test presented a greater predictive capacity for postoperative complications, although with a moderate but not high level of accuracy. 6. Differences in the predictive capacity of complications between the different nutritional tests were only shown between the NRS 2002 test and the MUST test. 7. The interobserver reliability of all nutritional screening tests is good in all parameters, although the MST, SNAQ and PG-SGA tests are considered “very good”. 8. The MST and SNAQ tests consume the least time to perform, being the PG-SGA and MNA the ones that require the most time to perform. However, the time required to perform these tests is not high.