Author(s)
Rushi Patel, BA
Sudeepti Vedula, BS
David Zakay, MD
Maria Manuela Chemas-Velez, MD
Prayag Patel, MD
Jean Anderson Eloy, MD FACS
Affiliation(s)
Rutgers New Jersey Medical School;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to evaluate the clinical utility of the Nutritional Risk Index in predicting postoperative complications for patients undergoing thyroid surgery.
Objectives: Previous studies on nutrition status in head and neck cancer patients have observed a significant association between nutritional status and postoperative complications. Our aim is to determine the clinical utility of the Nutritional Risk Index (NRI) in thyroid surgery.
Study Design: Retrospective database review.
Methods: The 2015-2018 National Surgical Quality Improvement Program (NSQIP) database was queried for all cases of thyroid surgery. Patients with missing height, weight, and albumin levels were excluded from the analysis. NRI score was calculated for each patient, and patients were subdivided depending on their nutritional status, into malnourished and non-malnourished. Univariate and multivariate analyses were conducted to assess the NRI's ability to predict postoperative complications.
Results: A total of 31,866 cases met inclusion criteria of which 615 (1.9%) were classified as being malnourished. There were significant differences in demographics and comorbidities between the two groups. Independent sample t-test demonstrated the malnourished group had a greater length of stay (6.76 vs. 1.36 days, p=<.001) and operative time (183.72 vs. 125.78 min, p=<.001). Multivariate regression analysis demonstrated NRI defined malnourishment, was a significant predictor of readmission (OR [95% CI]=1.655 [1.116-2.454], p=.012), and medical complications (OR [95% CI]=1.782 [1.096-2.897], p=.020). Individual complication analysis revealed significant association with organ space surgical site infection (OR [95% CI]=7.663 [1.237-47.46], p=.029), sepsis (OR [95% CI]=3.75 [1.191-11.809], p=.024), and septic shock (OR [95% CI]=8.121 [1.402-47.02], p=.019).
Conclusions: NRI can be a useful clinical tool to assess high risk patients and risk for readmission in patients undergoing thyroid surgery.