Nutritional risk factors in major hepatobiliary surgery.

Preoperative nutritional assessment was performed for 32 patients undergoing surgery for malignant hepatobiliary and pancreatic disease. Weight, mid-arm circumference, total body potassium (TBK), and skin test reactivity were significantly reduced in the seven patients who died after operation (p less than .05, Student's t-test and Fisher's exact test). Analyses of major life-threatening complications indicated that those who had a complicated postoperative course (17 patients) had a significantly lower TBK (p less than .05, Fisher's exact test). Using linear discriminant analysis (SPSS computer program), correct prediction of postoperative death or survival was possible in 85% of patients if measured by TBK alone, and in 83% if weight loss and serum albumin were used. Seventy three percent were correctly classified as complicated or uncomplicated by TBK alone, but serum albumin and weight loss were not helpful in predicting patients with complications. This study shows that malnutrition and operative risk may be identified preoperatively in patients with malignant hepatobiliary and pancreatic disease. Objective improvement may be achieved by intensive nutritional support.