# Using the comprehensive complication index to assess the impact of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition on postoperative complications after resection for biliary tract cancer

## TL;DR

This study shows that malnutrition, as defined by GLIM criteria, is strongly linked to higher postoperative complications in patients undergoing surgery for biliary tract cancer.

## Contribution

It is the first to evaluate GLIM-defined malnutrition's impact on postoperative outcomes in biliary tract cancer surgery.

## Key findings

- GLIM-defined malnutrition was present in 71.1% of patients.
- Malnutrition was an independent predictor of high morbidity (odds ratio 2.87).
- Intraoperative blood loss >1,000 mL also predicted high morbidity (odds ratio 3.77).

## Abstract

The Global Leadership Initiative on Malnutrition (GLIM) criteria, proposed in 2018, provide universal diagnostic standards for malnutrition, a known risk factor for postoperative complications in patients with various cancers. However, its impact on surgery for biliary tract cancer (BTC) remains unclear. This study evaluates the relationship between GLIM-defined malnutrition and postoperative complications after resection for BTC.

The subjects of this retrospective study were patients who underwent pancreaticoduodenectomy or major hepatectomy with extrahepatic bile duct resection for BTC between January, 2013 and December, 2021. The comprehensive complication index (CCI), an indicator of postoperative complications, was calculated based on the total number and severity of postoperative complications.

GLIM-defined malnutrition was diagnosed in143 (71.1%) of the total 201 patients. The median CCI was significantly higher in the GLIM-defined malnutrition group than in the non-malnutrition group (37.2 vs. 28.3; P < 0.001). Multivariate logistic regression analysis revealed that GLIM-defined malnutrition (odds ratio 2.87 [95% confidence interval 1.38–5.96], P = 0.005) and intraoperative blood loss > 1,000 mL (odds ratio 3.77 [95% confidence interval 1.06–13.47], P = 0.041) were independent predictors of high morbidity (CCI ≥ 37.1).

Preoperative GLIM-defined malnutrition was closely associated with increased postoperative complications in patients who underwent resection for BTC.

The online version contains supplementary material available at 10.1007/s00595-025-03051-9.