Multidimensional prognostic value of preoperative Prognostic Nutritional Index for postoperative outcomes in older adults undergoing major open abdominal surgery
Ruowen Xing, Zhixiang Zhang, Xiaomeng Sun, Yuheng Ma, Hao Zhang, Guanhua LiABSTRACT
Objective:
To evaluate the predictive value of the preoperative Prognostic Nutritional Index (PNI) for multidimensional postoperative outcomes in elderly patients undergoing major abdominal surgery.
Methods:
This single-center retrospective cohort study included 761 patients aged ≥65 years from 2015 to 2025. Patients were stratified into low-PNI (<40) and high-PNI (≥40) groups. The primary outcome was postoperative delirium within 7 days. Secondary outcomes included 90-day mortality, Clavien–Dindo classification, postoperative hospital stay, and functional recovery milestones (time to first ambulation, oral intake, and defecation). Multivariable regression models (logistic, Cox proportional hazards, and competing risk Fine-Gray models) were employed, adjusting for age, ASA grade, surgical factors, and comorbidities. PNI was further stratified into four categories (<35, 35–40, 40–45, and >45) for dose–response trend analysis.
Results:
Compared to the low-PNI group, the high-PNI group had a significantly lower risk of postoperative delirium (adjusted odds ratio [aOR] =0.21, 95% confidence interval [CI]:0.13–0.35,
Conclusion:
Preoperative PNI is a robust, independent predictor of multiple postoperative outcomes in elderly abdominal surgery patients. As a simple and cost-effective tool, PNI is well suited for preoperative risk stratification and guiding personalized perioperative management.