# Impact of Preoperative Nutritional Status on Postoperative Outcomes in Elective Brain Tumor Surgery: A Retrospective Cohort Study in the Philippines

## TL;DR

This study shows that poor preoperative nutrition increases in-hospital mortality after brain tumor surgery in the Philippines.

## Contribution

The study is one of the first to investigate the impact of preoperative nutritional status on outcomes in elective brain tumor surgery in a low- to middle-income country.

## Key findings

- Undernourished patients had significantly higher in-hospital mortality compared to well-nourished patients.
- Overnourished patients had the highest absolute mortality rate (7%) despite no significant differences in infection rates or hospital stay.
- Routine nutritional assessment is recommended to improve neurosurgical outcomes in this population.

## Abstract

Introduction: Malnutrition, encompassing undernutrition and overnutrition, is a modifiable risk factor for adverse surgical outcomes. While extensive literature links nutritional deficits to poor perioperative outcomes in general surgery, the role of nutrition in elective neurosurgery remains insufficiently characterized, particularly in low- and middle-income countries. This study examined the relationship between preoperative nutritional status and postoperative outcomes in patients undergoing elective brain tumor surgery in the Philippines.
Methods: A retrospective cohort study was conducted among adult patients (18-60 years) who underwent elective craniotomy for brain tumor excision at Vicente Sotto Memorial Medical Center (VSMMC) between December 2021 and December 2022. Patients were stratified by body mass index (BMI) into undernourished (<18.5 kg/m2), well-nourished (18.5-24.9 kg/m2), and overnourished (>25 kg/m2). Outcomes included in-hospital mortality, length of hospital stay, and postoperative infections. Statistical analyses employed t-tests, Mann-Whitney U tests, chi-square tests, and Fisher’s exact tests, with significance set at p<0.05.
Results: A total of 94 patients were included: six undernourished, 44 well-nourished, and 44 overnourished. Undernourished patients experienced significantly higher mortality compared to well-nourished patients (p=0.0176), while overnourished patients exhibited the highest absolute mortality (7%). No significant differences were observed in infection rates or hospital stay across groups.
Conclusion: Preoperative malnutrition is associated with increased in-hospital mortality in elective brain tumor surgery. Routine nutritional assessment and optimization should be incorporated into preoperative planning to improve neurosurgical outcomes.