Skip to main content
SpringerLink
Log in

The preoperative nutritional assessment of surgical patients with hepatic dysfunction

  • Original Articles
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

The precise influence of malnutrition on postoperative complications in patients with hepatic dysfunction is not well known. In phase I of the present study, we evaluated the nutritional status of 102 patients with hepatic dysfunction who were admitted for elective hepatobiliary or pancreatic surgery, and a model for the prediction of postoperative complications was developed using a computer-based stepwise regression procedure. The equation for this Prognostic Nutritional Index for Surgery (PNIS) was calculated by [−0.147×(% weight change)+0.046×(% ideal body weight)+0.010×(actual triceps skinfold thickness as a % of standard value)+0.051×(hepaplastintest)]. In phase II this model was prospectively tested in 182 patients, including 145 with hepatic dysfunction. A total of 18 patients were classified as having a poor prognosis (PNIS<5) and all of these patients in fact developed postoperative complications: 128 patients were classified as having an intermediate prognosis (5≤PNIS<10), 23 (18.0%) of whom developed postoperative complications, and none of the 36 patients who were classified as having a good prognosis (PNIS≥10) developed any postoperative complications. These results demonstrate the importance of performing a thorough preoperative nutritional assessment of patients with hepatic dysfunction as malnourished patients with PNIS<10 may need preoperative nutritional management, even when their surgical procedures are not major.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Higashiguchi T, Noguchi T, Kawarada Y, Mizumoto R (1986) Nutritional management before and after hepatectomy, with special reference to determination of the required total calories (in Japanese). Yueki Eiyou Journal (Jpn J Parent Ent Nutr) 8:457–463

    Google Scholar 

  2. Higashiguchi T, Noguchi T, Mizumoto R (1989) Primary liver cancer (in Japanese). KAN-TAN-SUI 19:49–57

    Google Scholar 

  3. Clowes GHA Jr, McDermott WV, Williams LF, Loda M, Menzoian JO, Pearl R (1984) Amino acid clearance and prognosis in surgical patients with cirrhosis. Surgery 96:675–685

    Google Scholar 

  4. Child CG, Turcotte JG (1964) Surgery in portal hypertension. In: Child CG (ed) Major problems in clinical surgery: The liver and portal hypertension. WB Saunders Philadelphia, pp 1–85

    Google Scholar 

  5. Higashiguchi T, Kosaka A, Noguchi T, Kawarada Y, Mizumoto R (1987) Clinical significance of physiological nutritional assessment, with special reference to TSH & AMC (in Japanese). Eiyou Assessment (J Nutr Asses) 4:221–225

    Google Scholar 

  6. Stadley HO (1936) Percentage of weight loss; a basic indicator of surgical risk in patients with chronic peptic ulcer. JAMA 106:458–460

    Google Scholar 

  7. Mullen JL, Buzby GP, Matthews DC, Smale BF, Rosato EF (1980) Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support. Ann Surg 192:604–613

    Google Scholar 

  8. Meakins JL, Pietsh JB, Bubenick O, Kelly R, Rode H, Gordon J, MacLean LD (1977) Delayed hypersensitivity: Indicator of acquire of host defenses in sepsis and trauma. Ann Surg 186:241–250

    Google Scholar 

  9. Mizumoto R, Noguchi T (1981) Estimation of functional reserve of the liver in hepatectomy. Asian Med J 24:293–312

    Google Scholar 

  10. Mizumoto R, Kawarada Y, Noguchi T (1979) Preoperative estimation of operative risk in liver surgery, with special reference to functional reserve of the remnant liver following major hepatic resection. Jpn J Surg 9:343–349

    Google Scholar 

  11. Noguchi T, Mizumoto R (1982) Estimation of operative risk and selection of operative procedures in liver surgery (in Japanese with English abstract). Nippon Shoukaki Geka Gakkai Zasshi (Jpn J Gastroenterol Surg) 15:717–721

    Google Scholar 

  12. Noguchi T, Imai T, Mizumoto R (1990) Preoperative estimation of surgical risk on hepatectomy in cirrhotic patients. Hepatogastroenterology 37:165–171

    Google Scholar 

  13. Blackburn GL, Bistrian BR, Maini BS, Schlamm HT, Smith MF (1977) Nutritional and metabolic assessment of the hospitalized patient. JPEN 1:11–22

    Google Scholar 

  14. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF (1980) Prognostic nutritional index in gastrointestinal surgery. Am J Surg 139:160–167

    Google Scholar 

  15. Dudrick SJ, Wilmore DW, Vars HW, Rhoads JE (1968) Longterm total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery 64:134–142

    Google Scholar 

  16. Fischer JE, Funovics JM, Aguirre A (1975) The role of plasma amino acids in hepatic encephalopathy. Surgery 78:276–289

    Google Scholar 

  17. Abel RM, Abbott WM, Fischer JE (1972) Intravenous essential L-amino acids and hypertonic dextrose in patients with acute renal failure. Am J Surg 123:632–638

    Google Scholar 

  18. Dudrick SJ, Steiger E, Long JM (1970) Renal failure in surgical patients. Treatment with intravenous essential amino acids and hypertonic glucose. Surgery 68:180–186

    Google Scholar 

  19. Cerra FB (1987) The hypermetabolism organ failure complex. World J Surg 11:173–181

    Google Scholar 

  20. Higashiguchi T, Mizumoto R (1989) Metabolic and nutritional management of hepatic failure following hepatectomy (in Japanese with English abstract). Saishin Igaku 44:134–141

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. First Department of Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, 514, Mie, Japan

    Takashi Higashiguchi, Hajime Yokoi, Takashi Noguchi, Yoshifumi Kawarada & Ryuji Mizumoto

  2. Department of Surgery, University of Cincinnati Medical Center, 231 Bethesda Avenue, 45267-0558, Cincinnati, OH, USA

    Per-Olof Hasselgren

Authors
  1. Takashi Higashiguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hajime Yokoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takashi Noguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshifumi Kawarada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryuji Mizumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Per-Olof Hasselgren
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Higashiguchi, T., Yokoi, H., Noguchi, T. et al. The preoperative nutritional assessment of surgical patients with hepatic dysfunction. Surg Today 25, 113–118 (1995). https://doi.org/10.1007/BF00311081

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00311081

Key Words

Search

Navigation