Nutritional status is a fundamental determinant of surgical outcomes, particularly in patients undergoing gastrointestinal (GI) surgeries. Malnutrition has been consistently associated with increased rates of postoperative complications, delayed wound healing, longer hospital stays, and higher mortality1,4. The GI tract plays a crucial role in nutrient absorption, and surgical interventions in this system can further compromise nutritional balance, thereby exacerbating the risk of adverse outcomes2.

Studies have shown that preoperative malnutrition, when left unaddressed, significantly influences the clinical trajectory following abdominal and oncologic GI surgeries3,5. Tools such as the Subjective Global Assessment (SGA), serum albumin, and BMI are commonly used to identify patients at nutritional risk, providing a simple yet effective means of risk stratification1,3.

Despite the strong evidence, nutritional assessment is often overlooked in surgical planning, especially in resource-limited settings. Early identification and intervention can play a critical role in reducing postoperative morbidity5. Oral and supplemental nutritional strategies have demonstrated benefits in improving clinical outcomes and reducing hospital length of stay in both cancer and non-cancer GI surgery patients6.

This study aims to assess the nutritional status of patients undergoing GI surgeries using SGA, BMI, and serum albumin levels, and to determine the impact of these parameters on postoperative complications and hospital stay. The findings are expected to reinforce the importance of early nutritional screening in surgical patients and guide strategies for improving surgical outcomes.

Study Design and Setting:

This prospective observational study was conducted at the Department of General Surgery, Government Medical College (GMC), Ananthapuramu, Andhra Pradesh, over a period of three months from 25th February 2024 to May 2024.

Study Population:

A total of 100 patients aged 18 years and above undergoing elective or emergency gastrointestinal (GI) surgeries were enrolled in the study. Informed written consent was obtained from all participants prior to inclusion. Patients undergoing non-GI surgeries or those with incomplete data were excluded.

Data Collection:

Baseline demographic details including age, gender, height, weight, and BMI were recorded. Nutritional status was assessed preoperatively using the Subjective Global Assessment (SGA) tool, serum albumin levels, and BMI.

Based on SGA classification, patients were categorized as:

SGA A: Well-nourished

SGA B: Moderately malnourished

SGA C: Severely malnourished

Preoperative laboratory investigations, type of GI surgery performed, and duration of hospital stay were documented. Patients were monitored postoperatively for complications such as wound infection, delayed wound healing, anastomotic leak, prolonged ileus (>5 days), and in-hospital mortality.

Outcome Measures:

The primary outcomes were the association between nutritional status and postoperative complications, and the correlation between nutritional parameters and length of hospital stay.

Statistical Analysis:

Data were entered into Microsoft Excel and analyzed using SPSS version 25.0. Descriptive statistics were used for demographic variables. Categorical variables were compared using the Chi-square test. Pearson correlation coefficient was used to assess the relationship between nutritional markers and hospital stay. A p-value <0.05 was considered statistically significant.

A total of 100 patients undergoing gastrointestinal (GI) surgeries were included in the study. The mean age of the participants was 54.2 ± 13.1 years, with a male predominance (58%). The mean BMI of the study population was 22.6 ± 3.9 kg/m². Based on Subjective Global Assessment (SGA), 38% were well-nourished (SGA A), 44% were moderately malnourished (SGA B), and 18% were severely malnourished (SGA C). The mean serum albumin level was 3.1 ± 0.7 g/dL (Table 1).

Table 1: Baseline Characteristics and Nutritional Status of Study Population (n = 100)

Among the surgical procedures performed, colorectal surgeries were the most common (32%), followed by hepatobiliary (20%) and gastric surgeries (18%). The mean hospital stay was highest among patients undergoing hepatobiliary procedures (11.4 ± 4.1 days) and lowest for those undergoing minor GI surgeries like appendectomies (5.2 ± 1.4 days). Overall, the average hospital stay across all surgical types was 9.3 ± 3.6 days (Table 2).

Table 2: Type of GI Surgery and Duration of Hospital Stay

Table 3: Postoperative Complications by Nutritional Status

Table 4: Correlation of Nutritional Markers with Length of Hospital Stay

This prospective observational study highlights the critical role of nutritional status in determining postoperative outcomes among patients undergoing gastrointestinal (GI) surgeries. Our findings reaffirm that malnutrition identified through Subjective Global Assessment (SGA), low serum albumin, and low BMI is significantly associated with increased complication rates and prolonged hospital stay.

In our cohort, 62% of patients were either moderately or severely malnourished preoperatively, aligning with previous literature that indicates malnutrition prevalence ranging from 50% to 70% in surgical populations7. Malnutrition adversely affects immune response, tissue regeneration, and wound healing, thereby increasing susceptibility to surgical complications8. In our study, the incidence of wound infections, delayed wound healing, and anastomotic leaks was substantially higher in the severely malnourished group (SGA C), emphasizing the prognostic importance of preoperative nutritional assessment.

These observations are consistent with the work of Kenny et al., who quantified that malnourished GI cancer patients face significantly greater risks of perioperative complications8. Similarly, Yamamoto et al. demonstrated that malnourished individuals with inflammatory bowel disease experienced higher surgical complication rates, irrespective of biologic therapy status9.

Serum albumin and BMI were inversely correlated with hospital stay, while SGA score showed a strong positive correlation, highlighting their utility as predictive tools (Table 4). Despite limitations in acute illness settings, serum albumin remains a robust marker of chronic nutritional status10.

Preoperative nutritional optimization has been shown to improve postoperative outcomes. Bhattacharyya et al. reported that implementing structured preoperative nutrition protocols significantly reduced complication rates and length of stay11. However, a gap persists between nutritional recommendations and real-world clinical practice, as noted by Cerantola et al., who stressed the need for integrating perioperative nutrition into standard surgical care12.

These findings support the incorporation of routine nutritional screening using simple tools like SGA and serum albumin levels. Early identification of at-risk patients enables targeted interventions such as dietary counseling, supplementation, or delaying elective procedures when feasible which may lead to improved recovery and reduced healthcare burden9-12.

Limitations of the study include its single-center design and relatively short follow-up period. Longitudinal studies with larger cohorts are recommended to assess long-term outcomes and validate these findings.

This study highlights the significant impact of preoperative nutritional status on postoperative outcomes in patients undergoing gastrointestinal surgeries. A considerable proportion of patients were found to be moderately to severely malnourished, which correlated with increased rates of wound infection, delayed healing, anastomotic leak, prolonged ileus, and mortality. Nutritional parameters such as serum albumin, BMI, and SGA scores were also strongly associated with the length of hospital stay. These findings underscore the importance of routine nutritional screening and timely intervention as part of preoperative care. Incorporating simple tools like SGA and serum albumin measurement can improve risk stratification and optimize surgical outcomes.

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