Usefulness of the Geriatric Nutritional Risk Index (GNRI) as a Predictor of Postoperative Complications After Colorectal Cancer Surgery

TL;DR

This study shows that the Geriatric Nutritional Risk Index (GNRI) can predict postoperative complications in colorectal cancer surgery patients, helping improve their care.

Contribution

The study demonstrates GNRI as an independent predictor of postoperative complications after adjusting for multiple risk factors in CRC surgery.

Findings

A GNRI cutoff of 94 predicted Clavien-Dindo grade ≥2 complications with high accuracy.

GNRI remained a significant independent predictor of complications after adjusting for age, sex, and other risk factors.

High-risk GNRI patients had significantly higher rates of postoperative ileus and delirium.

Abstract

Introduction: Postoperative complications following colorectal cancer (CRC) surgery are known to not only impair patients' quality of life but also adversely affect long-term prognosis. Objective and simple preoperative risk assessment tools are essential for preventing such complications. The Geriatric Nutritional Risk Index (GNRI), which incorporates serum albumin concentration and the ratio of current to ideal body weight, has emerged as a useful tool for estimating the risk of postoperative complications and long-term prognosis in patients with CRC. However, detailed investigations into its association with specific postoperative complications remain limited.

Methods: We retrospectively analyzed 105 consecutive patients who underwent CRC surgery between 2021 and 2023. Preoperative GNRI was calculated for each patient, and its association with postoperative complications was assessed. For comparison, the Prognostic Nutritional Index (PNI) and the Modified Glasgow Prognostic Score (mGPS) were also evaluated for postoperative complications.

Results: Receiver operating characteristic (ROC) curve analysis identified a GNRI cutoff value of 94 for predicting complications of Clavien-Dindo grade ≥2. Patients in the high-risk group (GNRI <94) had a significantly higher incidence of grade ≥2 complications compared to the low-risk group (14/35 (40%) vs. 14/70 (20%); p=0.029). In multivariable analysis, after adjusting for known risk factors (age, sex, American Society of Anesthesiologists Physical Status (ASA-PS), preoperative obstruction, emergency surgery, surgical approach, and tumor stage), GNRI remained the only significant independent predictor (odds ratio 2.90; p=0.049). While rates of anastomotic leakage and wound infection did not differ significantly between groups, postoperative ileus (6/35 (17%) vs. 1/70 (1.4%); p=0.002) and delirium (4/35 (11%) vs. 1/70 (1.4%); p=0.023) were significantly more frequent in the high-risk group.

Conclusion: GNRI is a simple and effective tool for predicting postoperative complications in CRC patients. Preoperative nutritional assessment using GNRI may enhance perioperative safety and enable more personalized surgical care.

Figures