The Emerging Impact of Malnutrition on Surgical Patients: Literature Review and Potential Implications on Cystectomy for Bladder Cancer

Malnutrition is emerging as a significant factor in patient outcomes. A contemporary review of malnutrition for the urologist has not been performed. We provide a review of the available literature and current standards of care for malnutrition screening, assessment, and intervention with a focus on patients with bladder cancer treated with cystectomy.

Our multi-disciplinary team conducted a PubMed search of available literature on malnutrition focusing on: definition and significance, importance to urologists, screening, assessment, diagnosis, immunologic and economic impact, and interventions.

The prevalence of malnutrition in hospitalized patients has been estimated to range from 15-60% and as high as 71% in cancer patients. Malnutrition has been shown to increase inflammatory markers, further increasing catabolism and weight loss. Bladder cancer is catabolic and patients undergoing cystectomy have an increase in resting energy expenditure postoperatively. There is emerging data on the impact of malnutrition in the cystectomy population. Recent studies have identified the association between nutritional status based on low albumin or sarcopenia (loss of muscle) with an adverse impact on length of stay, complications, and survival. The current standard of care malnutrition assessment tool is the 2012 Consensus Statement, which has not been assessed in the urologic literature. Perioperative immunonutrition in colorectal surgery has been associated with significant decreases in postoperative complications, and recent pilot work has identified the potential for immunonutrition to positively impact the cystectomy population.

Malnutrition has a significant impact on surgical patients including bladder cancer patients. There is emerging evidence in the urologic literature on how to best identify and improve the nutritional status of cystectomy patients. Additional work is needed to identify malnutrition and intervene to improve surgical outcomes.

The Journal of urology. 2017 Mar 09 [Epub ahead of print]

Conrad M Tobert, Jill M Hamilton-Reeves, Lyse A Norian, Chermaine Hung, Nathan A Brooks, Jeff M Holzbeierlein, Tracy M Downs, Douglas P Robertson, Ruth Grossman, Kenneth G Nepple

University of Iowa, Iowa City, IA., University of Kansas, Kansas City, KS., University of Alabama-Birmingham, Birmingham, AL., University of Wisconsin, Madison, WI., University of Iowa, Iowa City, IA. Electronic address: .