The preoperative nutritional assessment of surgical patients with hepatic dysfunction.

The precise influence of malnutrition on postoperative complications in patients with hepatic dysfunction is not well known. In phase I of the present study, we evaluated the nutritional status of 102 patients with hepatic dysfunction who were admitted for elective hepatobiliary or pancreatic surgery, and a model for the prediction of postoperative complications was developed using a computer-based stepwise regression procedure. The equation for this Prognostic Nutritional Index for Surgery (PNIS) was calculated by [-0.147 x (% weight change) + 0.046 x (% ideal body weight) + 0.010 x (actual triceps skinfold thickness as a % of standard value) + 0.051 x (hepaplastintest)]. In phase II this model was prospectively tested in 182 patients, including 145 with hepatic dysfunction. A total of 18 patients were classified as having a poor prognosis (PNIS < 5) and all of these patients in fact developed postoperative complications: 128 patients were classified as having an intermediate prognosis (5 < or = PNIS < 10), 23 (18.0%) of whom developed postoperative complications, and none of the 36 patients who were classified as having a good prognosis (PNIS > or = 10) developed any postoperative complications. These results demonstrate the importance of performing a thorough preoperative nutritional assessment of patients with hepatic dysfunction as malnourished patients with PNIS < 10 may need preoperative nutritional management, even when their surgical procedures are not major.