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Nutrition in acute and chronic diseases

Skeletal muscle depletion and nutrition support affected postoperative complications in patients who underwent pancreatoduodenectomy

European Journal of Clinical Nutrition volume 75, pages 1218–1226 (2021)Cite this article

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Abstract

Background

Body composition has been shown closely related to the outcome in surgical patients. The aim of the present study was to investigate whether preoperative skeletal muscle condition and postoperative nutrition would affect major complications in patients underwent pancreaticoduodenectomy (PD).

Methods

This retrospective study included 265 patients underwent PD. Body composition data was extracted from the L3 level of the preoperative CT scan. Univariable and multivariable regression analyses were performed to investigate correlations between body composition data and postoperative complications. Furthermore, a subgroup analysis was conducted to explore the relationship between postoperative nutrition strategy and the outcome.

Results

Of all the 265 patients, major complications occurred in 81 patients (30.6%). Cutoff values for skeletal muscle depletion were defined by ROC curve analysis from postoperative complications in skeletal muscle index (SMI) (male 47.32 cm2/m2 and female 40.65 cm2/m2). Univariable analysis and multivariable regression revealed age (OR 1.49, 95% CI 1.22–1.83, p = 0.026), SMI (OR 0.77, 95% CI 0.51–0.94, p = 0.015) and skeletal muscle density (SMD) (OR 0.85, 95% CI 0.64–1.03, p = 0.029) were independent predictors for major complications. Subgroup analysis showed the initial parenteral nutrition time (IPNT) (OR 1.89, 95% CI 1.43–2.49, p = 0.032) and average protein delivery (APD) (OR 0.76, 95% CI 0.53–0.89, p = 0.021) were significantly associated with major complications in patients with lower SMI.

Conclusions

Preoperative skeletal muscle index and density were independently associated with major complications in patients underwent PD. In patients with lower SMI, early parenteral nutrition and higher protein delivery were related to better outcome.

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Fig. 1: Nutritional effect to the postoperative complications.

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Funding

This research was supported by National Natural Science Foundation of China (81700788, 81800714).

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Author notes

  1. These authors contributed equally: Kaipeng Duan, Xin Gao

Authors and Affiliations

  1. Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China

    Kaipeng Duan, Xin Gao, Luxin Wei, Jin Zhou & Dongming Zhu

  2. Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China

    Mengting Gong

  3. Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, PR China

    Bin Feng

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Contributions

DZ, JZ, and KD conceived and designed the study. KD, XG, MG, and BF performed data collection and analysis. KD, LW drafted the article. All authors proved the final version of the article.

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Correspondence to Jin Zhou or Dongming Zhu.

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Duan, K., Gao, X., Wei, L. et al. Skeletal muscle depletion and nutrition support affected postoperative complications in patients who underwent pancreatoduodenectomy. Eur J Clin Nutr 75, 1218–1226 (2021). https://doi.org/10.1038/s41430-020-00851-9

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