Impacto da sobreposição da desnutrição e da provável sarcopenia em pacientes oncológicos submetidos a operação de grande porte

Abstract

Malnutrition and probable sarcopenia (PS), when present in patients undergoing major surgery, can cause negative postoperative outcomes. However, few studies investigate the overlap of both diagnoses (OBD) associated with complications in postoperative cancer patients. Aim: To evaluate the association of malnutrition, probable sarcopenia (PS) and the overlap of both diagnoses (OBD) with complications and mortality in the postoperative period of cancer patients undergoing major surgery. Method: Prospective cohort study, carried out with cancer patients undergoing major surgery. The main variable being the presence of complications and mortality in the postoperative period. Patients with subjective global assessment (SGA) B and C were considered malnourished. The diagnosis of probable sarcopenia (PS) was defined in the immediate preoperative period and on the 2nd postoperative day, using the Strength, Assistance with walking, Rise from a chair, Climb stairs - and Falls (SARC-F) questionnaire, and low handgrip strength (HGS). Results: 353 patients were eligible, with a median age of 59 (48 - 66) years, 55,8 % female. There was a worsening of the parameters to determine PS and its frequency, as well as OBD from the preoperative period to the 2nd postoperative day (p< 0,001). Preoperatively, those who were malnourished were those who had a greater chance of general complications (OR= 0,4 CI95% 1,5-3.8; p< 0,001), infectious complications (OR= 3,6 CI95% 1,7- 7.7; p< 0,001) and Clavien Dindo ≥3 (OR= 1,9I C95% 1,05-3.5; p= 0.033), than those who were not malnourished. Patients with OBD were those who presented more than twice the chance of infectious complications (OR= 2,56 CI95% 1,1-6.0; p= 0,025) and Clavien Dindo ≥3 (OR= 2,46 CI95% 1,1-5.6; p= 0,028). Postoperatively, there was an association between all outcomes studied, with the presence of malnutrition, PS and OBD. Conclusion: There was a worsening of all outcomes studied from pre- to post-operative, also, patients who presented these diagnoses in the post-operative period showed a greater chance of complications and mortality.