Utilizing the Nutritional Risk Index as a Predictor of Postoperative Complications in Ventral Skull Base Surgery

Objectives: Previous studies have characterized significant associations between nutritional status and postoperative patient outcomes. The Nutritional Risk Index (NRI) has been shown to identify patients at risk for complications in different surgical fields. Our aim is to determine the utility of the NRI in predicting postoperative outcomes for patients undergoing ventral skull base surgery.

Study Design: Present study is a retrospective database review.

Methods: We queried the 2012 to 2018 National Surgical Quality Improvement Program (NSQIP) database for all patients undergoing ventral skull base surgery. We excluded cases with missing height, weight, and albumin levels. The NRI score was calculated for each patient, and patients were subdivided depending on their nutritional status, into malnourished and non-malnourished. We conducted univariate and multivariate analyses to assess the NRI's ability to predict postoperative complications.

Results: A total of 2,099 patients met inclusion criteria. Of these patients, 96 (4.6%) had NRI-defined malnourishment and 392 (18.7%) developed a postoperative complication. Malnourished patients were significantly more likely to be male (62.5 vs. 50.5%, p = 0.022) and older than 65 years (43.8 vs. 31.4%, p=0.011). There were also differences in comorbidities between the malnourished and nourished cohorts, respectively, including obesity (0 vs. 47.4%, p < 0.001), smoking (37.5 vs. 16.7%, p < 0.001), and disseminated cancer (13.5 vs. 5.6%, p = 0.001). Independent samples t-test demonstrated that the malnourished cohort had significantly longer length of stay (13.41 vs. 6.56 days, p < 0.001) and operation times (306.66 vs. 263.98 min, p < 0.001). Univariate analysis revealed NRI-defined malnourishment was significantly associated with increased rates of all complications (p < 0.001), medical complications (p = 0.001), and surgical complications (p < 0.001). Specific complication analysis showed elevated rates for bleeding (p < 0.001), urinary tract infection (p = 0.050), acute renal failure (p = 0.002), renal insufficiency (p = 0.001), ventilator dependence >48 hours (p = 0.001), reintubation (p = 0.005), sepsis (p = 0.017), and pneumonia (p = 0.010). After multivariate regression analysis, significant associations remained for all complications (OR = –[95% CI]: 1.838 [1.103-3.063], p = 0.019) and surgical complications (OR [95% CI]: 1.901 [1.084–3.334], p = 0.035). However, the associations did not remain significant on specific complication analysis.

Conclusion: NRI is clinical tool to assess malnutrition in patients. For patients undergoing ventral skull base surgery, NRI-defined malnourishment is associated with increased risk for all complications and surgical complications, but this association was not attributable to any specific complication.

Publication History

Article published online:
15 February 2022