Malnutrition and Adverse Effects in Cardiac Surgery

With great interest, we read the recent article by Fiorelli et al[1] regarding the association between the nutritional status and outcome of elderly patients resected for lung cancer. The authors very clearly discussed the relationship between malnutrition and adverse outcome of patients undergoing surgery. They showed that malnutrition was a significant additional risk factor for early death, and nutritional assessment should be included in the routine preoperative selection. In addition to their discussion, we would like to present our findings from a previous study in this area to emphasize the association between the malnutrition and outcome of patients undergoing cardiac surgery.

Malnutrition is a major health problem in spite of the developments in the field of health. Malnourished patients have higher mortality and morbidity rates and longer length of hospital stay than patients without malnutrition. In our study,[2] we aimed to investigate rates of malnutrition in hospitalized patients undergoing open heart surgery and the associated risk factors. Fifty ASA II–III patients in the age group of 40 and 85 undergoing elective open heart surgery were enrolled. Patients whose NRS-2002 score was ≥ 3 and/or,[3] body mass index was < 18.5 kg/m², and/or serum albumin level was < 3 g/dL were evaluated as malnourished. Length of stay in intensive care unit (ICU) and type of complications that occurred during hospitalization were recorded. We found that the rate of malnutrition was 20% in patients with open heart surgery in our hospital. Patients at risk of malnutrition had longer postoperative intubation time, length of stay in ICU, and higher rates of postoperative infectious and cardiovascular complications than those without risk of malnutrition. Infectious complications were observed in all patients with malnutrition. As a result, there was a significant association between the preoperative nutritional status of patients and postoperative outcomes.

We would like to congratulate Fiorelli et al[1] for their effort to show the importance of nutritional status on outcome of elderly patients resected for lung cancer. In addition, we agree with authors that the nutritional assessment should be included in the routine preoperative selection of elderly patients. Also, we hope that the above-mentioned items would add to the value of the well-written article by Fiorelli et al.

• References

• 1 Fiorelli A, Vicidomini G, Mazzella A , et al. The influence of body mass index and weight loss on outcome of elderly patients undergoing lung cancer resection. Thorac Cardiovasc Surg 2014; 62 (7) 578-587
• 2 Bayir H, Tekelioglu ÜY, Kocoglu H , et al. Investigation of malnutrition rates and related risk factors in open heart surgery. Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society 2014; 20 (4) 209-214
• 3 Kondrup J, Allison SP, Elia M, Vellas B, Plauth M ; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22 (4) 415-421