Bariatric patients' nutritional status as a risk factor for postoperative complications, prolonged length of hospital stay and hospital readmission: A retrospective cohort study

Background: The prevalence of obesity is growing worldwide. Malnutrition has been identified as a risk factor, leading to higher morbidity rate and prolonged length of hospital. So far there are no high quality data on the impact of malnutrition on length of hospital stay and morbidity regarding bariatric surgery. The aim of the study was to assess association between nutritional status and outcomes bariatric surgeries. Material and methods: The study was a prospective observational study. Inclusion criteria: informed consent to participate in the study, age 18-65 years, meeting the eligibility criteria for bariatric treatment, qualification for laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y Gastric By-pass (LRYGB). Exclusion criteria: revision surgery, lack of necessary data. The primary endpoint was the evaluation of protein malnutrition risk prevalence. Secondary: influence of malnutrition risk patients' on treatment course and postoperative complications. Results: 533 patients ma inclusion criteria and were analyzed. 169 patients (32%) had qualitative risk of malnutrition. The body mass index (BMI) was significantly higher in malnutritioned group, p = 0.001. Albumins in malnutritioned group was 38 g/l (IQR 35-42), whereas in control group it was 41 g/l (IQR 39-43), p = 0.027. Lymphocyte count in malnutrition risk group and control group were 1.24 10'3/mu 1 (IQR 1.1-1.37) and 1.94 10'3/mu l (IQR1.7-2.3) respectively, p < 0.001. In linear regression model, a correlation between BMI and total number of lymphocytes was present, p < 0.001. Malnutrition risk did not affect the total morbidity rate. There was a difference in occurrence of postoperative nausea and vomiting, p = 0.033. Conclusions: Higher BMI is associated with greater risk of malnutrition. Proper perioperative care may diminish the impact of malnutrition on adverse effects and length of stay (LOS).