Prospective Evaluation of Nutritional Factors to Predict the Risk of Complications for Patients Undergoing Radical Cystectomy: A Cohort Study

ABSTRACT

The objective of this study was to identify nutritional preoperative factors associated with complications after radical cystectomy (RC). We prospectively evaluated the Mini-Nutritional Assessment Score, body mass index (BMI), appetite, stool frequency, hydration, food intake, weight loss, albuminemia, and prealbuminemia of 144 patients who underwent RC between January 2011 and April 2014. Postoperative complications were defined as any adverse event reported in the patient's file up to 90 days after surgery. Each complication was classified according to the Clavien–Dindo and Memorial Sloan–Kettering Cancer Center systems. The adjusted relative risk (RR) computed through a Poisson regression model was used to identify nutritional risk factors associated with post-RC complications. A high BMI >27 kg/m² was associated with higher risk of low-grade complications (RR:1.47 [95% CI,1.09–2.00]) at 7 days and a four-fold increased risk of cardiac complications at 7 and 90 days (RR:3.77 [1.15–12.32] and RR:3.28 [1.35–7.98]). Decreased appetite was associated with low-grade (RR:1.43 [1.03–1.99] complications within 90 days. Preoperative weight loss >3 kg was associated with high-grade (RR:2.49 [1.23–5.05]) and wound (RR:2.51 [1.23–5.10]) complications within 90 days. This study showed that preoperative nutritional status of patients may predict the occurrence of complications up to 90 days post-RC. Development of preoperative nutritional interventions may reduce the deleterious impact of RC on patients' health.

Author Contributions

JA, YF, LL, and VF designed the study protocol; JA and TBZ collected data; JA and VF performed analysis of results; CL assisted in the interpretation of results; JA and MNM conducted the statistical analyses; JA and VF wrote the manuscript; CL, TBZ, YF, and LL edited the manuscript. All authors have read and approved the manuscript. The authors declare no conflict of interest.

Acknowledgments

The authors thank Celine Veilleux for the revision of patients' files and Hélène Hovington for the management of the database. We also thank Dr. Karine Robitaille for the critical reading of this manuscript. Finally, the authors thank the CHU de Québec – University Laval for supporting the time of the healthcare professionals who evaluated each patient before surgery. This study was also supported by internal research funds managed by LL and VF. A career Junior 2 award from the Fonds de recherche du Québec – Santé supported VF.

Funding

JA is recipient of a scholarship from the Fonds de Recherche du Québec – Santé (FRQ-S) and from Canadian Institutes of Health Research (CIHR). VF is a recipient of a FRQ-S clinician-scientist Junior 2 award.