The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer
BackgroundMini-invasive surgery (MIS), ERAS, and preoperative nutritional screening are currently used to reduce complications and the length of hospital stay (LOS); however, inter-variable correlations have seldom been explored. This research aimed to define inter-variable correlations in a large s...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2023.1041153/full |
| _version_ | 1827989100718718976 |
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| author | Laura Lorenzon Riccardo Caccialanza Valentina Casalone Gloria Santoro Paolo Delrio Francesco Izzo Marco Tonello Maria Cristina Mele Carmelo Pozzo Paolo Pedrazzoli Andrea Pietrabissa Piero Fenu Alfredo Mellano Elisabetta Fenocchio Antonio Avallone Francesca Bergamo Maria Teresa Nardi Roberto Persiani Alberto Biondi Flavio Tirelli Annamaria Agnes Renato Ferraris Virginia Quarà Michela Milanesio Dario Ribero Marilena Rinaldi Paola D'Elia Maurizio Rho Carola Cenzi Domenico D'Ugo |
| author_facet | Laura Lorenzon Riccardo Caccialanza Valentina Casalone Gloria Santoro Paolo Delrio Francesco Izzo Marco Tonello Maria Cristina Mele Carmelo Pozzo Paolo Pedrazzoli Andrea Pietrabissa Piero Fenu Alfredo Mellano Elisabetta Fenocchio Antonio Avallone Francesca Bergamo Maria Teresa Nardi Roberto Persiani Alberto Biondi Flavio Tirelli Annamaria Agnes Renato Ferraris Virginia Quarà Michela Milanesio Dario Ribero Marilena Rinaldi Paola D'Elia Maurizio Rho Carola Cenzi Domenico D'Ugo |
| author_sort | Laura Lorenzon |
| collection | DOAJ |
| description | BackgroundMini-invasive surgery (MIS), ERAS, and preoperative nutritional screening are currently used to reduce complications and the length of hospital stay (LOS); however, inter-variable correlations have seldom been explored. This research aimed to define inter-variable correlations in a large series of patients with gastrointestinal cancer and their impact on outcomes.MethodsPatients with consecutive cancer who underwent radical gastrointestinal surgery between 2019 and 2020 were analyzed. Age, BMI, comorbidities, ERAS, nutritional screening, and MIS were evaluated to determine their impact on 30-day complications and LOS. Inter-variable correlations were measured, and a latent variable was computed to define the patients' performance status using nutritional screening and comorbidity. Analyses were conducted using structural equation modeling (SEM).ResultsOf the 1,968 eligible patients, 1,648 were analyzed. Univariable analyses documented the benefit of nutritional screening for LOS and MIS and ERAS (≥7 items) for LOS and complications; conversely, being male and comorbidities correlated with complications, while increased age and BMI correlated with worse outcomes. SEM analysis revealed that (a) the latent variable is explained by the use of nutritional screening (p0·004); (b) the variables were correlated (age–comorbidity, ERAS–MIS, and ERAS–nutritional screening, p < 0·001); and (c) their impact on the outcomes was based on direct effects (complications: sex, p0·001), indirect effects (LOS: MIS-ERAS-nutritional screening, p < 0·001; complications: MIS-ERAS, p0·001), and regression-based effects (LOS: ERAS, MIS, p < 0·001, nutritional screening, p0·021; complications: ERAS, MIS, p < 0·001, sex, p0·001). Finally, LOS and complications were correlated (p < 0·001).ConclusionEnhanced recovery after surgery (ERAS), MIS, and nutritional screening are beneficial in surgical oncology; however, the inter-variable correlation is reliable, underlying the importance of the multidisciplinary approach. |
| first_indexed | 2024-04-10T00:14:00Z |
| format | Article |
| id | doaj.art-0b032e1be91742459d783220990a5ac9 |
| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-04-10T00:14:00Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nutrition |
| spelling | doaj.art-0b032e1be91742459d783220990a5ac92023-03-16T06:41:48ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2023-03-011010.3389/fnut.2023.10411531041153The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancerLaura Lorenzon0Riccardo Caccialanza1Valentina Casalone2Gloria Santoro3Paolo Delrio4Francesco Izzo5Marco Tonello6Maria Cristina Mele7Carmelo Pozzo8Paolo Pedrazzoli9Andrea Pietrabissa10Piero Fenu11Alfredo Mellano12Elisabetta Fenocchio13Antonio Avallone14Francesca Bergamo15Maria Teresa Nardi16Roberto Persiani17Alberto Biondi18Flavio Tirelli19Annamaria Agnes20Renato Ferraris21Virginia Quarà22Michela Milanesio23Dario Ribero24Marilena Rinaldi25Paola D'Elia26Maurizio Rho27Carola Cenzi28Domenico D'Ugo29Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyFondazione IRCCS Policlinico San Matteo, Pavia, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyFondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyIstituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, ItalyIstituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, ItalyVeneto Institute of Oncology IOV-IRCCS, Padua, ItalyFondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyFondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyFondazione IRCCS Policlinico San Matteo, Pavia, ItalyFondazione IRCCS Policlinico San Matteo, Pavia, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyIstituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, ItalyVeneto Institute of Oncology IOV-IRCCS, Padua, ItalyVeneto Institute of Oncology IOV-IRCCS, Padua, ItalyFondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyFondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyFondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyFondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyCandiolo Cancer Institute–IRCCS, Turin, ItalyIstituto Nazionale per lo Studio e la Cura dei Tumori Fondazione Giovanni Pascale IRCCS, Naples, ItalyVeneto Institute of Oncology IOV-IRCCS, Padua, ItalyFondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, ItalyBackgroundMini-invasive surgery (MIS), ERAS, and preoperative nutritional screening are currently used to reduce complications and the length of hospital stay (LOS); however, inter-variable correlations have seldom been explored. This research aimed to define inter-variable correlations in a large series of patients with gastrointestinal cancer and their impact on outcomes.MethodsPatients with consecutive cancer who underwent radical gastrointestinal surgery between 2019 and 2020 were analyzed. Age, BMI, comorbidities, ERAS, nutritional screening, and MIS were evaluated to determine their impact on 30-day complications and LOS. Inter-variable correlations were measured, and a latent variable was computed to define the patients' performance status using nutritional screening and comorbidity. Analyses were conducted using structural equation modeling (SEM).ResultsOf the 1,968 eligible patients, 1,648 were analyzed. Univariable analyses documented the benefit of nutritional screening for LOS and MIS and ERAS (≥7 items) for LOS and complications; conversely, being male and comorbidities correlated with complications, while increased age and BMI correlated with worse outcomes. SEM analysis revealed that (a) the latent variable is explained by the use of nutritional screening (p0·004); (b) the variables were correlated (age–comorbidity, ERAS–MIS, and ERAS–nutritional screening, p < 0·001); and (c) their impact on the outcomes was based on direct effects (complications: sex, p0·001), indirect effects (LOS: MIS-ERAS-nutritional screening, p < 0·001; complications: MIS-ERAS, p0·001), and regression-based effects (LOS: ERAS, MIS, p < 0·001, nutritional screening, p0·021; complications: ERAS, MIS, p < 0·001, sex, p0·001). Finally, LOS and complications were correlated (p < 0·001).ConclusionEnhanced recovery after surgery (ERAS), MIS, and nutritional screening are beneficial in surgical oncology; however, the inter-variable correlation is reliable, underlying the importance of the multidisciplinary approach.https://www.frontiersin.org/articles/10.3389/fnut.2023.1041153/fullstructural equation modeling (SEM)nutritional screeningsurgical oncologymini-invasive surgerydigestive cancers |
| spellingShingle | Laura Lorenzon Riccardo Caccialanza Valentina Casalone Gloria Santoro Paolo Delrio Francesco Izzo Marco Tonello Maria Cristina Mele Carmelo Pozzo Paolo Pedrazzoli Andrea Pietrabissa Piero Fenu Alfredo Mellano Elisabetta Fenocchio Antonio Avallone Francesca Bergamo Maria Teresa Nardi Roberto Persiani Alberto Biondi Flavio Tirelli Annamaria Agnes Renato Ferraris Virginia Quarà Michela Milanesio Dario Ribero Marilena Rinaldi Paola D'Elia Maurizio Rho Carola Cenzi Domenico D'Ugo The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer Frontiers in Nutrition structural equation modeling (SEM) nutritional screening surgical oncology mini-invasive surgery digestive cancers |
| title | The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer |
| title_full | The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer |
| title_fullStr | The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer |
| title_full_unstemmed | The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer |
| title_short | The impact of preoperative nutritional screening, ERAS protocol, and mini-invasive surgery in surgical oncology: A multi-institutional SEM analysis of patients with digestive cancer |
| title_sort | impact of preoperative nutritional screening eras protocol and mini invasive surgery in surgical oncology a multi institutional sem analysis of patients with digestive cancer |
| topic | structural equation modeling (SEM) nutritional screening surgical oncology mini-invasive surgery digestive cancers |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2023.1041153/full |
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