Patients With Poor Nutritional Status Before Radical Cystectomy Have a Higher Risk of Postoperative Complications
Patients with bladder cancer are two times more likely to have complications after a radical cystectomy procedure if they have a biomarker for poor nutritional status before the operation, according to study findings presented at the 2013 Clinical Congress of the American College of Surgeons. Surgeons from the University of North Carolina School of Medicine, Chapel Hill, identified a potentially modifiable risk factor for such postsurgical problems: a low preoperative level of albumin.
Radical cystectomy, which involves surgical removal of the bladder and lymph nodes, is the standard treatment for patients whose bladder cancer has spread to the muscular wall of the bladder. However, the complication rate after the operation remains high, particularly for infections and poor wound healing, explained study authors.
“Poor nutrition is a known risk factor for adverse results after radical cystectomy,” explained David C. Johnson, MD, MPH, lead author of the study and a third-year urology resident at UNC School of Medicine. “The prevalence of nutritional deficiency is very high in patients with bladder cancer, partly because of their disease and partly because of their advanced age—73 years on average.”
Study Details
Dr. Johnson and colleagues evaluated the impact of patients’ nutritional status before radical cystectomy on the rate of complications within 30 days after the operation. Researchers mined the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) database to analyze postoperative complications data from 1,085 patients who underwent radical cystectomy at 315 medical centers across the United States from 2005 to 2011.
Among study patients who experienced complications within the first month after the surgical procedure, the authors looked for the presence of any of three known preoperative nutritional factors that could affect surgical results. These factors were a low albumin level (< 3 g/dL), weight loss > 10% of body weight 6 months before the operation, and obesity (body mass index [BMI] ≥ 30 kg/m2).
Low Albumin a Significant Predictor of Postoperative Complication
Study results showed that 575 patients (53%) experienced complications within the first month after the surgical procedure. Of these patients, 32 (6%) had a low preoperative albumin level, 28 (5%) had major weight loss within the 6 months before the operation, and 182 (32%) were obese at cystectomy.
The investigators found that only low albumin level was a significant predictor of experiencing a postoperative complication, after controlling in the statistical analysis for patient age, involvement of a trainee surgeon in the operation, the year the operation took place, and a history of a prior operation. Patients with low albumin levels before the surgical procedure had 2.1 times the risk of having a complication within 30 days after the operation compared with those whose albumin level was in a normal range or above (3 g/dL and higher), the authors reported.
It is unclear from this study whether preoperative correction of low albumin levels, such as from nutritional supplementation, will translate to fewer problems after radical cystectomy. However, based on their findings, Dr. Johnson recommended that patients whose albumin levels are low before a scheduled radical cystectomy see a nutritionist to learn whether they need to make dietary changes before their operations.
“There’s very little risk in improving nutritional status before the operation and significant possible benefits,” said study coauthor Angela Smith, MD, Assistant Professor of Urology at UNC.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
