Malnutrition and Surgical Outcomes: Making a Connection for Patients in Total Pancreatectomy with Islet Autotransplantation

Abstract

Research Question: How does presurgical nutritional status for patients undergoing total pancreatectomy with autoislet transplantation correlate with intraoperative and postoperative complications?

Background and Significance: For patients suffering severe pain refractory to medical management due to chronic pancreatitis, a possible therapeutic approach is a total pancreatectomy. As a result of this surgery, many patients suffer from brittle diabetes due to the removal of the islets of Langerhans, which contain the endocrine cells that function to control glycemic levels. Surgical intervention of either autologous or allogenic islet transplantation, using either the patient¿s own pancreatic islets or donor islets, can restore secretion of pancreatic hormones necessary for energy regulation. Patient nutritional status has been shown to have a significant impact on postsurgical outcomes for a variety of surgeries. However, it has not been extensively studied in patients undergoing pancreatic islet transplantation following total pancreatectomy. The focus of this retrospective study is to look at patients who have undergone total pancreatectomy with autoislet transplantation to control pain for chronic pancreatitis and compare the postoperative outcomes of patients who are undernourished, compared to well-nourished, and look for correlations between these two groups. This research will help surgeons have improved predictive power for achieving positive surgical outcomes which might be used to better screen and prepare patients for surgery.

Materials and Methods: Data for this study was collected through REDCap, Microsoft Excel, and the electronic medical record Epic. Measures of the patients¿ nutritional status such as their subjective global assessments and presurgical BMIs were also obtained. Intraoperative complications and blood loss were recorded. Postoperative variables that were recorded include length of hospital and ICU stays, surgical complications, and feeding tube duration. Data was compiled and analyzed using Microsoft Excel and GraphPad Prism.

Results: The anticipated result was that poor nutritional status prior to TPIAT surgery would be correlated with an increased likelihood of complications. Despite our smaller data set of patients who underwent nutritional evaluation accessible through Epic, there was a trend for patients who were moderately nourished to have fewer postsurgical complications (36%) compared with those that were well-nourished (54%), although due to our small sample size the difference was not statistically significant. Despite this lower percentage, a relatively higher percentage of moderately nourished patients had more severe complications of a Clavien-Dindo classification III or above than those that were well nourished (66% of total complications compared to 14%). Length of total hospital stay was not statistically different between moderately nourished (13 days) and well-nourished (15 days, p-value: 0.63). Length of stay in intensive care was also similar between moderately nourished (1.9 days) and well-nourished (1.5 days, p-value: 0.36).

Conclusion: Nutritional status of patients has been shown to be an important prognostic indicator to help evaluate patients for surgery. In TPIAT, more patient data is needed to confidently discern a correlation between presurgical nutrition and surgical complications. However, patients who are undernourished appear to experience more severe complications than their well-nourished counterparts. Despite this observation, there does not appear to have differing hospital lengths of stay or any difference in time spent requiring critical care that correlates with presurgical nutritional status.