Nutritional Risk Screening 2002 as a Predictor of Postoperative Outcomes in Patients Undergoing Abdominal Surgery: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Zhen Sun, Xin-Juan Kong, Xue Jing, Run-Jun Deng, Zi-Bin Tian, Zhen Sun, Xin-Juan Kong, Xue Jing, Run-Jun Deng, Zi-Bin Tian

Abstract

Background: The nutritional risk screening (NRS 2002) has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery.

Methods: A systematic literature search for published papers was conducted using the following online databases: MEDLINE, EMBASE, the Cochrane library, EBSCO, CRD databases, Cinahl, PsycInfo and BIOSIS previews. The pooled odds ratio (OR) or weight mean difference (WMD) was calculated using a random-effect model or a fix-effect model.

Results: Eleven studies with a total of 3527 patients included in this study. Postoperative overall complications were more frequent in nutritional risk patients versus patients without nutritional risk (the pooled OR 3.13 [2.51, 3.90] p<0.00001). The pooled OR of mortality for the nutritional risk group and non-nutritional risk group was 3.61 [1.38, 9.47] (p = 0.009). Furthermore, the postoperative hospital stay was significant longer in the preoperative nutritional risk group than in the nutritional normal group (WMD 5.58 [4.21, 6.95] p<0.00001).

Conclusions: The present study has demonstrated that patients at preoperative nutritional risk have increased complication rates, high mortality and prolonged hospital stay after surgery. However, NRS 2002 needs to be validated in larger samples of patients undergoing abdominal surgery by better reference method.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of the study…
Fig 1. Flow diagram of the study selection process.
Fig 2. Forest plot showing the effects…
Fig 2. Forest plot showing the effects of nutritional risk group compared to nutritional normal group on overall complications.
SE, standard error; IV, inverse variance; CI, confidence interval.
Fig 3. Funnel plots for the overall…
Fig 3. Funnel plots for the overall complications in nutritional risk group compared to nutritional normal group.
SE, standard error; OR, odds ratio.
Fig 4. Forest plot showing the effects…
Fig 4. Forest plot showing the effects of nutritional risk group compared to nutritional normal group on infective complications.
SE, standard error; IV, inverse variance; CI, confidence interval.
Fig 5. Forest plot showing the effects…
Fig 5. Forest plot showing the effects of nutritional risk group compared to nutritional normal group on mortality.
SE, standard error; IV, inverse variance; CI, confidence interval.
Fig 6. Forest plot showing the effects…
Fig 6. Forest plot showing the effects of nutritional risk group compared to nutritional normal group on length of hospital stay.
SE, standard error; IV, inverse variance; CI, confidence interval.

References

    1. Jie B, Jiang ZM, Nolan MT, Zhu SN, Yu K, Kondrup J. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition. 2012;28: 1022–1027. 10.1016/j.nut.2012.01.017
    1. Sungurtekin H, Sungurtekin U, Balci C, Zencir M, Erdem E. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23: 227–232.
    1. Hill AG, Hill GL. Metabolic response to severe injury. Br J Surg. 1998; 85: 884–890.
    1. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22: 235–239.
    1. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krahenbuhl L, Meier R, et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr. 2008;27: 340–349. 10.1016/j.clnu.2008.03.012
    1. Fan ST, Lo CM, Lai EC, Chu KM, Liu CL, Wong J. Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. N Engl J Med. 1994;331: 1547–1552.
    1. Velasco C, Garcia E, Rodriguez V, Frias L, Garriga R, Alvarez J, et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr. 2011;65: 269–274. 10.1038/ejcn.2010.243
    1. van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP, de Vet HC. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr. 2014;33: 39–58. 10.1016/j.clnu.2013.04.008
    1. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22: 321–336.
    1. Zhou W, Xu X, Yan J, Mou Y. Nutritional risk is still a clinical predictor of postoperative outcomes in laparoscopic abdominal surgery. Surg Endosc. 2013;27: 2569–2574. 10.1007/s00464-013-2790-1
    1. Wu LM, Zhou FR, Lin QF, Li H, Li LH. [Impact of nutritional status on postoperative outcomes for patients with colorectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi. 2011;14: 271–274.
    1. Han D, He J, Huang QL. [Predictive value of three preoperative nutritional assessment methods in postoperative complications of gastrointestinal cancers]. Zhonghua Wei Chang Wai Ke Za Zhi. 2013;16: 1067–1072.
    1. Song F, Sheldon TA, Sutton AJ, Abrams KR, Jones DR. Methods for exploring heterogeneity in meta-analysis. Eval Health Prof. 2001;24: 126–151.
    1. Egger M, Smith GD, Phillips AN. Meta-analysis: principles and procedures. BMJ. 1997;315: 1533–1537.
    1. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25: 603–605. 10.1007/s10654-010-9491-z
    1. Schiesser M, Muller S, Kirchhoff P, Breitenstein S, Schafer M, Clavien PA. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery. Clin Nutr. 2008;27: 565–570. 10.1016/j.clnu.2008.01.010
    1. Guo W, Ou G, Li X, Huang J, Liu J, Wei H. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results. J Gastroenterol Hepatol. 2010;25: 800–803. 10.1111/j.1440-1746.2009.06198.x
    1. Shinkawa H, Takemura S, Uenishi T, Sakae M, Ohata K, Urata Y, et al. Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy. Surg Today. 2013;43: 276–283. 10.1007/s00595-012-0350-2
    1. Kwag SJ, Kim JG, Kang WK, Lee JK, Oh ST. The nutritional risk is a independent factor for postoperative morbidity in surgery for colorectal cancer. Ann Surg Treat Res. 2014;86: 206–211. 10.4174/astr.2014.86.4.206
    1. Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Muhlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97: 92–97. 10.1002/bjs.6805
    1. Kuppinger D, Hartl WH, Bertok M, Hoffmann JM, Cederbaum J, Kuchenhoff H, et al. Nutritional screening for risk prediction in patients scheduled for abdominal operations. Br J Surg. 2012;99: 728–737. 10.1002/bjs.8710
    1. Liu H, Hu YF, Li GX. [Association between the score of preoperative nutritional risk screening and anastomotic leakage following anterior resection for the rectal cancer]. Zhonghua Wei Chang Wai Ke Za Zhi. 2013;16: 552–554.
    1. Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics. Clin Nutr. 2006;25: 180–186.
    1. Ozkalkanli MY, Ozkalkanli DT, Katircioglu K, Savaci S. Comparison of tools for nutrition assessment and screening for predicting the development of complications in orthopedic surgery. Nutr Clin Pract. 2009;24: 274–280. 10.1177/0884533609332087
    1. Tevik K, Thurmer H, Husby MI, de Soysa AK, Helvik AS. Nutritional risk screening in hospitalized patients with heart failure. Clin Nutr. 2014;34: 257–264
    1. Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr. 2006;25: 224–244.

Source: PubMed

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