EP183 - Significance of the Prognostic Nutritional Index in Adult Patients Undergoing Colorectal Surgery: A Retrospective Cohort Study of the ACS-NSQIP 2016-2022

Saturday, May 9, 2026

3:31 PM - 3:36 PM ET

ePoster Presenter(s)

SA

Swati Anant, BHSc

Medical student
McMaster University
Hamilton, Ontario, Canada

Disclosure information not submitted.

View ePoster

Author(s)

Tyler McKechnie, MD MSc PhD(c) (he/him/his)

Resident Physician
McMaster University
McMaster University
Hamilton, ON, Canada

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
SR

Sahaar Rattansi, BSc

Student
University of Waterloo
Waterloo, Ontario, Canada

Disclosure information not submitted.
Haseeb Khan, MDCM., MBA (he/him/his)

General Surgery Resident
McMaster University
Ancaster, ON, Canada

Disclosure information not submitted.
IY

Ilun Yang, MD

Staff
McMaster University
Hamilton, Ontario, Canada

Disclosure information not submitted.
AD

Aristithes Doumouras, MD MPH

General Surgeon
Associate Professor, Division of General Surgery, McMaster University
Hamilton, Ontario, Canada

Disclosure information not submitted.
DH

Dennis Hong, MD, MSc

Associate Professor, Surgery
Division of General Surgry, McMaster University
Hamilton, Ontario, Canada

Disclosure information not submitted.

Senior Author(s)

Cagla Eskicioglu, MD, MSc (she/her/hers)

Associate Professor, Surgery
Division of General Surgery, McMaster University
Hamilton, ON, Canada

All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Purpose/Background: Preoperative malnutrition prior to colorectal surgery is associated with an increased risk of anastomotic leakage, surgical site infections, postoperative sepsis, and more. The prognostic nutritional index (PNI), calculated as serum albumin concentration (g/dL) x 10 + total lymphocyte count (/mm3) x 5, is a potentially useful indicator of patients' nutritional and inflammatory status. We retrospectively evaluated the association between the PNI and postoperative morbidity in adult patients undergoing intra-abdominal colorectal surgery.

Methods/Interventions: Patients who underwent elective colorectal surgery for colorectal neoplasia, diverticular disease, or inflammatory bowel disease between 2016-2022 were selected from ACS-NSQIP database. The exposure of interest was malnutrition, based on a PNI of less than 50. The comparators were patients with a PNI greater than 50, classified as non-malnourished. The primary outcome was 30-day postoperative mortality. Secondary outcomes included 30-day major postoperative morbidity, reoperation with 30 days, and postoperative length of stay (LOS). Multivariable regression models were fit for each outcome.

Results/Outcomes: Overall, 350,233 patients were included (malnourished: n=5,574 (1.5%), non-malnourished: n=344,660 (98.5%)). Compared to non-malnourished patients, malnourished patients were at an increased risk of postoperative mortality (4.9% vs 1.2%, p< 0.001) and morbidity (23.2% vs 12.6%, p< 0.001). On multivariable analysis, malnourishment was associated with 85% increased odds of postoperative mortality (95%CI 1.61-2.14, p< 0.001), 27% increased odds of postoperative morbidity (95%CI 1.19-1.36, p< 0.001), and 20% increased odds of requiring reoperation (95%CI 1.07-1.34, p< 0.001). Postoperative LOS was nearly a day longer in patients who were malnourished (MD 0.86, 95%CI 0.71-1.01, p< 0.001).

Conclusion/Discussion: Patients experiencing malnutrition according to a PNI less than 50 are at an increased risk of postoperative morbidity and mortality and have higher healthcare resource utilization following elective colorectal surgery as compared to patients not experiencing malnutrition. The PNI may be a useful prognostic tool for identifying at-risk patients and developing interventions for optimizing patients' nutritional status.