AUTHOR=Lorenzon Laura , Caccialanza Riccardo , Casalone Valentina , Santoro Gloria , Delrio Paolo , Izzo Francesco , Tonello Marco , Mele Maria Cristina , Pozzo Carmelo , Pedrazzoli Paolo , Pietrabissa Andrea , Fenu Piero , Mellano Alfredo , Fenocchio Elisabetta , Avallone Antonio , Bergamo Francesca , Nardi Maria Teresa , Persiani Roberto , Biondi Alberto , Tirelli Flavio , Agnes Annamaria , Ferraris Renato , Quarà Virginia , Milanesio Michela , Ribero Dario , Rinaldi Marilena , D'Elia Paola , Rho Maurizio , Cenzi Carola , D'Ugo Domenico 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 JOURNAL=Frontiers in Nutrition VOLUME=10 YEAR=2023 URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1041153 DOI=10.3389/fnut.2023.1041153 ISSN=2296-861X ABSTRACT=Background

Mini-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.

Methods

Patients 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).

Results

Of 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).

Conclusion

Enhanced 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.