Re-evaluation of the Usefulness of the Prognostic Nutritional Index Reported by Onodera, Especially for the Elderly Patients Undergoing Gastrointestinal Surgery for the Gastric and Colon Cancer

Hisao Wakabayashi, Tsuyoshi Otani, Akihiro Kondo and Seiji Mori

Department of Surgery, Sakaide Municipal General Hospital

Background: We evaluated the prognostic nutritional index (PNI), reported by Onodera, in patients undergoing gastrointestinal surgery for the gastric and colon cancer, and compared criteria for risk evaluation between younger and older patients. Methods: Subjects were 65 patients, 38 with gastric cancer, 18 with colon cancer, and 9 with rectal cancer, rated as Stage I or II. We evaluated the relationship between patient age and preoperative PNI, dividing by postoperative course into those with and without complications. We compared PNI was compared between groups. Patients were further assigned by age into an older group (>75) or younger group. PNI was also compared between these groups. Results: The correlation between patient PNI and age was negative. The PNI in patients without complications was 42.9±5.7, while that in those with complications was 37.8±4.3, statistically significant (P=0.003). PNI in older patients was 39.8±5.0, while that in younger patients was 44.5±5.7, again statistically significant (P=0.001). In older and younger patients with complications, PNI was significantly lower in the older group at 35.5±4.8, versus 40.0±3.0 in the younger group (P=0.045). In the relationship between PNI and age relative to the postoperative course, a demarcation (PNI=46.2-0.071 × Age) was observed between patients without and with complications. Conclusion: PNI decreased concomitantly with aging. In originally reported risk assessment criteria, most older patients were evaluated as risky or contraindicated for surgery. The demarcation line decreased concomitantly with age, indicating that preoperative risk assessment of older patients should take into account the decrease in PNI with aging.

Key words
prognostic nutritional index, elderly patients, gastrointestinal surgery, postoperative complication, older patients

Reprint requests
Hisao Wakabayashi Department of Surgery, Sakaide Municipal General Hospital
1-6-43 Bunkyocho, Sakaide-city, 762-0031 JAPAN

Accepted
December 19, 2003

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