Abstract A113: Preoperative Geriatric Nutritional Risk Index Predicts Postoperative Morbidity and Mortality After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A NSQIP study
Murtuza Hassan, Julien Hohenleitner, Sepideh Gholami, Danielle K. DePeralta, Gerardo A. Vitiello, Daniel A. King, Matthew J. Weiss, Elliot Newman, Marcovalerio MelisAbstract
Background:
Malnutrition is common in patients undergoing resection for pancreatic ductal adenocarcinoma (PDAC) and is linked to poor postoperative outcomes. The Geriatric Nutritional Risk Index (GNRI), a validated scoring scale calculated with serum albumin and body weight (relative to ideal weight), has been associated with adverse outcomes, but its prognostic value in PDAC has not been evaluated at a national scale. We determined whether preoperative GNRI independently predicts 30-day postoperative morbidity and mortality after pancreaticoduodenectomy (PD) for PDAC.
Methods:
We performed a retrospective cohort study using ACS NSQIP (2014-2023). Adults undergoing PD for histologically confirmed PDAC with complete preoperative albumin, height, and weight were included. GNRI was categorized as No Risk (>98), Low Risk (92-98), or Moderate-High Risk (≤92). Multivariable logistic regression assessed GNRI category against 30-day mortality (primary), reoperation, delayed gastric emptying, postoperative pancreatic fistula (POPF grade B/C), and length of stay, adjusting for age, sex, ASA class, diabetes, smoking, and biliary stent status.
Results:
Among 22,101 patients (mean age 67 years), 52.7% had normal GNRI, 23.1% low risk, and 24.2% moderate-high risk nutritional status. Moderate-high risk GNRI independently predicted 30-day mortality (OR 1.58, 95% CI 1.26-1.98, p<0.001), reoperation (OR 1.48, p<0.001), longer length of stay (+31%, p<0.001), and postoperative renal complications (OR 2.16, p<0.001). GNRI was not associated with POPF (OR 0.99, p=0.83) or organ/space surgical site infection.
Conclusion:
In this large, national, single-procedure PDAC cohort, poor preoperative nutrition independently predicted systemic postoperative morbidity and mortality. GNRI is a simple, low-cost preoperative tool that may aid risk stratification and perioperative counseling before pancreaticoduodenectomy.
Citation Format:
Murtuza Hassan, Julien Hohenleitner, Sepideh Gholami, Danielle K. DePeralta, Gerardo A. Vitiello, Daniel A. King, Matthew J. Weiss, Elliot Newman, Marcovalerio Melis. Preoperative Geriatric Nutritional Risk Index Predicts Postoperative Morbidity and Mortality After Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A NSQIP study [abstract]. In: Proceedings of the AACR Conference on Pancreatic Cancer: New Frontiers in Biology and Therapeutic Development; 2026 Sep 25-28; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(18_Suppl_2):Abstract nr A113.