Archives of Gynecology and Obstetrics

, Volume 284, Issue 2, pp 445–451 | Cite as

Malnutrition as a predictor of poor postoperative outcomes in gynecologic cancer patients

  • Anupama S. Q. KathiresanEmail author
  • Kathleen F. Brookfield
  • Samer I. Schuman
  • Joseph A. LucciIII
Gynecologic Oncology



Poor nutritional status has been associated with increased postoperative morbidity and mortality in surgical patients. The purpose of this study is to evaluate if decreased nutritional parameters correlate with increased postoperative complications regardless of other risk factors in the gynecologic cancer patient.


A retrospective chart review was performed among women who underwent surgical management for gynecologic malignancies from October 2006 to June 2008. Variables included age, race, medical comorbidities, cancer type/stage, preoperative albumin, absolute lymphocyte count (ALC), and body mass index (BMI), estimated blood loss (EBL), intraoperative blood transfusion (BT), intraoperative or postoperative complications, intensive care unit (ICU) admissions, hospital readmissions, reoperations, and cancer recurrence.


Three hundred gynecologic oncology patients with preoperative nutritional parameters were included in the study. Decreased albumin was significantly associated with more postoperative complications (p < 0.001), hospital readmissions (p = 0.01), reoperations (p = 0.03), ICU admissions (p < 0.001), and cancer recurrence (p < 0.001). Decreased ALC and BMI preoperatively was also significantly associated with higher incidence of cancer recurrence (p = 0.01, p = 0.01). Surgical cases involving increased EBL (p = 0.01, p < 0.001) and more BT (p < 0.001, p < 0.001) had significantly more postoperative complications and more ICU admissions. Multivariable logistic regression found preoperative albumin to be an independent predictor of increased postoperative complications.


Decreased albumin is significantly associated with more postoperative complications, hospital readmissions, reoperations, ICU admissions, and cancer recurrence. This nutritional parameter is an important predictor of postoperative morbidity and mortality. Thus, it is important to assess nutritional status preoperatively and offer nutritional support or alternate treatment options if necessary.


Malnutrition Albumin Postoperative complications Gynecology oncology 


Conflict of interest



  1. 1.
    Laky B, Janda M, Bauer J et al (2007) Malnutrition among gynaecological cancer patients. Eur J Clin Nutr 61:642–646PubMedGoogle Scholar
  2. 2.
    Ottery FD (1994) Cancer cachexia: prevention, early diagnosis, and management. Cancer Pract 2:123–131PubMedGoogle Scholar
  3. 3.
    Lipschitz DA (1988) Protein-energy malnutrition. Hosp Pract (Off Ed) 23:87–99Google Scholar
  4. 4.
    McClave SA, Mitoraj TE, Thielmeier KA et al (1992) Differentiating subtypes (hypoalbuminemic vs. marasmic) of protein-calorie malnutrition: incidence and clinical significance in a university hospital setting. JPEN J Parenter Enteral Nutr 16:337–342PubMedCrossRefGoogle Scholar
  5. 5.
    Berek JS, Hacker NF (2005) Practical gynecologic oncology, 4th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  6. 6.
    Detsky AS, Baker JP, O’Rourke K et al (1987) Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. JPEN J Parenter Enteral Nutr 11:440–446PubMedCrossRefGoogle Scholar
  7. 7.
    Daley J, Khuri SF, Henderson W et al (1997) Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the national veterans affairs surgical risk study. J Am Coll Surg 185:328–340PubMedGoogle Scholar
  8. 8.
    Symeonidis PD, Clark D (2006) Assessment of malnutrition in hip fracture patients: effects on surgical delay, hospital stay and mortality. Acta Orthop Belg 72:420–427PubMedGoogle Scholar
  9. 9.
    Casey J, Flinn WR, Yao JS et al (1983) Correlation of immune and nutritional status with wound complications in patients undergoing vascular operations. Surgery 93:822–827PubMedGoogle Scholar
  10. 10.
    Jain G, Mukerji G, Dixit A et al (2007) The impact of nutritional status on the outcome of Indian patients undergoing neurosurgical shunt surgery. Br J Nutr 98:944–949PubMedCrossRefGoogle Scholar
  11. 11.
    Rapp-Kesek D, Stahle E, Karlsson TT (2004) Body mass index and albumin in the preoperative evaluation of cardiac surgery patients. Clin Nutr 23:1398–1404PubMedCrossRefGoogle Scholar
  12. 12.
    Geisler JP, Linnemeier GC, Thomas AJ et al (2007) Nutritional assessment using prealbumin as an objective criterion to determine whom should not undergo primary radical cytoreductive surgery for ovarian cancer. Gynecol Oncol 106:128–131PubMedCrossRefGoogle Scholar
  13. 13.
    Alphs HH, Zahurak ML, Bristow RE et al (2006) Predictors of surgical outcome and survival among elderly women diagnosed with ovarian and primary peritoneal cancer. Gynecol Oncol 103:1048–1053PubMedCrossRefGoogle Scholar
  14. 14.
    Santoso JT, Canada T, Latson B et al (2000) Prognostic nutritional index in relation to hospital stay in women with gynecologic cancer. Obstet Gynecol 95:844–846PubMedCrossRefGoogle Scholar
  15. 15.
    Muller JM, Brenner U, Dienst C et al (1982) Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet 1:68–71PubMedCrossRefGoogle Scholar
  16. 16.
    The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group (1991) Perioperative total parenteral nutrition in surgical patients. N Engl J Med 325:525–532Google Scholar
  17. 17.
    Bellantone R, Doglietto GB, Bossola M et al (1988) Preoperative parenteral nutrition in the high risk surgical patient. JPEN J Parenter Enteral Nutr 12:195–197PubMedCrossRefGoogle Scholar
  18. 18.
    Detsky AS, Baker JP, O’Rourke K et al (1987) Perioperative parenteral nutrition: a meta-analysis. Ann Intern Med 107:195–203PubMedGoogle Scholar
  19. 19.
    Dempsey DT, Mullen JL, Buzby GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr 47:352–356PubMedGoogle Scholar
  20. 20.
    Heyland DK, Montalvo M, MacDonald S et al (2001) Total parenteral nutrition in the surgical patient: a meta-analysis. Can J Surg 44:102–111PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Anupama S. Q. Kathiresan
    • 1
    Email author
  • Kathleen F. Brookfield
    • 1
  • Samer I. Schuman
    • 2
  • Joseph A. LucciIII
    • 2
  1. 1.Department of Obstetrics and Gynecology, Miller School of Medicine, Jackson Memorial HospitalUniversity of MiamiMiamiUSA
  2. 2.Division of Gynecologic Oncology, Department of Obstetrics and GynecologyMiller School of Medicine, Jackson Memorial HospitalMiamiUSA

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