Evaluating the predictive performance of nutritional indices in postoperative outcomes following pancreaticoduodenectomy in the elderly

Görkem Özdemir; Ahmet Şeker; Alper Sözütek; Hızır Taner Coşkun; Zeynep Kahyaoğlu

doi:10.38053/acmj.1629140

Evaluating the predictive performance of nutritional indices in postoperative outcomes following pancreaticoduodenectomy in the elderly

Authors : Görkem Özdemir, Ahmet Şeker, Alper Sözütek, Hızır Taner Coşkun, Zeynep Kahyaoğlu

Pages : 271-277

Doi:10.38053/acmj.1629140

View : 70 | Download : 88

Publication Date : 2025-05-30

Article Type : Research Paper

Abstract :Aims: The aim of the study was to evaluate the prognostic significance of nutritional indices including geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and total bilirubin-albumin ratio (TBAR) in predicting postoperative outcomes following pancreaticoduodenectomy (PD) among elderly patients. Methods: This study retrospectively analyzed 192 patients aged 65 and older who underwent PD at a single center. Postoperative complications were graded using the Clavien-Dindo classification. Postoperative survival was defined as survival beyond 90 days. All deaths that occurred during follow-up were included in the assessment of long-term mortality. In addition, the duration of hospital stay was assessed. Results: The mean age of the participants was 71.6±5.3 (range: 65–87) years. The mean follow-up time was 22.5±20.9 months (median: 15.0 months, IQR: 6.0-36.0). Postoperative complications occurred in 51.0% of patients, with pancreatic fistulae developing in 27.6%. GNRI demonstrated superior predictive accuracy for both 90-day and long-term mortality compared to PNI and TBAR. Lower GNRI scores were significantly associated with worse survival outcomes. Multivariate Analysis revealed that age, GNRI, and the presence of postoperative complications were independent predictors of 90-day mortality. GNRI was the only significant predictor of long-term mortality in the Cox regression model. Conclusion: Preoperative GNRI demonstrated superior predictive performance compared to PNI and TBAR in predicting postoperative survival following PD in elderly patients. Lower GNRI scores were strongly associated with increased mortality risk. We suggest routine screening for malnutrition using tools like GNRI to identify these vulnerable patients at increased risk of mortality following PD.
Keywords : Elderly, geriatrics, geriatric nutritional risk index, nutrition, pancreaticoduodenectomy, prognostic nutritional index, survival

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