{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T10:58:56Z","timestamp":1791543536564,"version":"4.3.4"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Pancreaticoduodenectomy (PD) is a major surgery associated with significant morbidity and mortality, especially in older adult patients. Malnutrition is a common complication in these patients and is linked to poorer outcomes. This study aimed to investigate the associations between preoperative nutritional status using the Geriatric Nutritional Risk Index (GNRI) and postoperative outcomes in older adult patients who underwent PD. Methods: A retrospective cohort study was conducted on 363 older adult patients who underwent PD. The preoperative GNRI was calculated based on serum albumin levels and body mass index. GNRI \u2264 82, GNRI 83 to \u226498, and GNRI &gt; 98 were classified as severely malnourished, moderately\/mildly malnourished, and no malnourishment, respectively. Perioperative data, including demographics, comorbidities, and postoperative complications, were collected. Univariate and multivariate analyses were performed to assess the associations between the GNRI and outcomes such as length of hospital stay, postoperative complications, and overall survival. Results: Patients with a higher GNRI were more likely to experience Clavien\u2013Dindo grade \u2265 3b postoperative complications (42.1% vs. 22.0% vs. 14.1%; p = 0.027) and pulmonary complications (26.3% vs. 11.9% vs. 4.2%; p = 0.016). These patients also stayed at the hospital for a longer duration (17.0% vs. 16.0% vs. 11.0%; p &lt; 0.001). Multivariate analysis confirmed that the GNRI was an independent predictor of adverse outcomes, even after adjusting for other confounding factors. Conclusions: Our findings highlight the importance of preoperative nutritional assessment in older adult patients undergoing PD. Patients with low GNRI scores are at increased risk of postoperative complications and prolonged recovery. These results underscore the need for targeted nutritional interventions and regular monitoring of these patients. Future studies should focus on interventions to improve nutritional status in older adult patients undergoing PD.<\/jats:p>","DOI":"10.3390\/jcm14020655","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T12:32:52Z","timestamp":1737376372000},"page":"655","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["High Geriatric Nutritional Risk Index Risk as a Predictor of Postoperative Complications and Early Mortality in Older Adult Patients Undergoing Pancreatoduodenectomy for Periampullary Malignancies"],"prefix":"10.3390","volume":"14","author":[{"given":"Ming-Hung","family":"Wang","sequence":"first","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Hung","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan"},{"name":"Weight Management Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueh-Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Yin","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Feng","family":"Li","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Ting","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Szu-Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Hsi","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Min","family":"Yin","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Dapi Road, Niaosong District, Kaohsiung 833, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7025","DOI":"10.3748\/wjg.v23.i38.7025","article-title":"Trends and outcomes of pancreaticoduodenectomy for periampullary tumors: A 25-year single-center study of 1000 consecutive cases","volume":"23","author":"Askar","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Yin, S.M., Liu, Y.W., Liu, Y.Y., Yong, C.C., Wang, C.C., Li, W.F., and Yeh, C.H. (2021). Short-term outcomes after minimally invasive versus open pancreaticoduodenectomy in elderly patients: A propensity score-matched analysis. BMC Surg., 21.","DOI":"10.1186\/s12893-021-01052-2"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wang, Q., Chen, C., and Li, H. (2022). Laparoscopic pancreaticoduodenectomy in elderly patients: Systematic review and meta-analysis. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.807940"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s00423-013-1072-7","article-title":"Perioperative and long-term outcomes after pancreaticoduodenectomy in elderly patients 80 years of age and older","volume":"398","author":"Oguro","year":"2013","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14701\/ahbps.2020.24.1.1","article-title":"Hepatobiliary and pancreatic surgery in the elderly: Current status","volume":"24","author":"Papis","year":"2020","journal-title":"Ann. Hepatobiliary Pancreat. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Ruan, G.T., Ge, Y.Z., Xie, H.L., Hu, C.L., Zhang, Q., Zhang, X., Tang, M., Song, M.M., Zhang, X.W., and Liu, T. (2021). Association between systemic inflammation and malnutrition with survival in patients with cancer sarcopenia-a prospective multicenter study. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.811288"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s00384-021-04039-w","article-title":"Poor nutrition and sarcopenia are related to systemic inflammatory response in patients with rectal cancer undergoing preoperative chemoradiotherapy","volume":"37","author":"Abe","year":"2022","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/S1499-3872(14)60284-8","article-title":"Inflammatory response related scoring systems in assessing the prognosis of patients with pancreatic ductal adenocarcinoma: A systematic review","volume":"13","author":"Ahmad","year":"2014","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"107074","DOI":"10.1016\/j.ejso.2023.107074","article-title":"Malnutrition in cancer patients: Causes, consequences and treatment options","volume":"50","author":"Arends","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.clnu.2018.04.007","article-title":"Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points","volume":"38","author":"Marshall","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1245\/s10434-018-6342-8","article-title":"Impact of malnutrition after gastrectomy for gastric cancer on long-term survival","volume":"25","author":"Fujiya","year":"2018","journal-title":"Ann. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"6347","DOI":"10.21873\/anticanres.13846","article-title":"The impact of immunonutritional and physical status on surgical outcome after pancreaticoduodenectomy in elderly patients","volume":"39","author":"Sugimachi","year":"2019","journal-title":"Anticancer. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, X., Yang, M., Ge, Y., Tang, M., Rao, B., Chen, Y., Xu, H., Cong, M., Guo, Z., and Shi, H. (2021). Association of systemic inflammation and malnutrition with survival in nasopharyngeal carcinoma undergoing chemoradiotherapy: Results from a multicenter cohort study. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.766398"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hou, T.Y., Lin, Y.H., Liu, Y.W., Liu, Y.Y., Li, W.F., Kuo, M.C., Huang, S.W., Yeh, C.H., Lin, Y.C., and Yin, S.M. (2024). The impact of preoperative nutritional status on postoperative outcomes: An insight from Geriatric Nutritional Risk Index in elderly pancreaticoduodenectomy patients. BMC Surg., 24.","DOI":"10.1186\/s12893-024-02397-0"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3365","DOI":"10.1245\/s10434-018-6699-8","article-title":"Clinical Impact of Neoadjuvant Therapy on Nutritional Status in Pancreatic Cancer","volume":"25","author":"Tashiro","year":"2018","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106850","DOI":"10.1016\/j.ejso.2023.02.007","article-title":"Long-term nutrition in patients candidate to neoadjuvant and adjuvant treatments","volume":"50","author":"Lovey","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.nut.2009.07.010","article-title":"Comparison of nutritional risk screening tools for predicting clinical outcomes in hospitalized patients","volume":"26","author":"Raslan","year":"2010","journal-title":"Nutrition"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.clnesp.2018.12.002","article-title":"Geriatric Nutrition Risk Index is comparable to the mini nutritional assessment for assessing nutritional status in elderly hospitalized patients","volume":"29","year":"2019","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/ajcn\/82.4.777","article-title":"Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients","volume":"82","author":"Bouillanne","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Sasaki, M., Miyoshi, N., Fujino, S., Ogino, T., Takahashi, H., Uemura, M., Matsuda, C., Yamamoto, H., Mizushima, T., and Mori, M. (2020). The Geriatric Nutritional Risk Index predicts postoperative complications and prognosis in elderly patients with colorectal cancer after curative surgery. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-67285-y"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2345","DOI":"10.18632\/oncotarget.27635","article-title":"Preoperative geriatric nutritional risk index is a useful prognostic indicator in elderly patients with gastric cancer","volume":"11","author":"Hirahara","year":"2020","journal-title":"Oncotarget"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Liao, C.K., Chern, Y.J., Hsu, Y.J., Lin, Y.C., Yu, Y.L., Chiang, J.M., Yeh, C.Y., and You, J.F. (2021). The clinical utility of the geriatric nutritional risk index in predicting postoperative complications and long-term survival in elderly patients with colorectal cancer after curative surgery. Cancers, 13.","DOI":"10.3390\/cancers13225852"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Matsunaga, T., Saito, H., Osaki, T., Takahashi, S., Iwamoto, A., Fukuda, K., Taniguchi, K., Kuroda, H., Takeuchi, T., and Sugamura, K. (2022). Impact of geriatric nutritional risk index on outcomes after gastrectomy in elderly patients with gastric cancer: A retrospective multicenter study in Japan. BMC Cancer, 22.","DOI":"10.1186\/s12885-022-09638-6"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e20671","DOI":"10.1097\/MD.0000000000020671","article-title":"Geriatric nutritional risk index is associated with 30-day mortality in patients with acute respiratory distress syndrome","volume":"99","author":"Yoo","year":"2020","journal-title":"Medicine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.hrtlng.2021.07.012","article-title":"The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study","volume":"50","author":"Shi","year":"2021","journal-title":"Heart Lung"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/TA.0000000000003588","article-title":"The Geriatric Nutritional Risk Index as a predictor of complications in geriatric trauma patients","volume":"93","author":"Kregel","year":"2022","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.2147\/RMHP.S298959","article-title":"Association of a low geriatric nutritional risk index with higher adverse outcome in the elderly patients with fall injuries: Analysis of a propensity score-matched population","volume":"14","author":"Huang","year":"2021","journal-title":"Risk Manag. Healthc. Policy"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after","volume":"161","author":"Bassi","year":"2017","journal-title":"Surgery"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.jamcollsurg.2016.10.029","article-title":"American College of Surgeons and Surgical Infection Society: Surgical site infection guidelines, 2016 Update","volume":"224","author":"Ban","year":"2017","journal-title":"J. Am. Coll. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/bja\/aex002","article-title":"Postoperative pulmonary complications","volume":"118","author":"Miskovic","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Norman, K., Hass, U., and Pirlich, M. (2021). Malnutrition in older adults-recent advances and remaining challenges. Nutrients, 13.","DOI":"10.3390\/nu13082764"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.maturitas.2013.07.013","article-title":"Malnutrition in the elderly: A narrative review","volume":"76","author":"Agarwal","year":"2013","journal-title":"Maturitas"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Rovesti, G., Valoriani, F., Rimini, M., Bardasi, C., Ballarin, R., Di Benedetto, F., Menozzi, R., Dominici, M., and Spallanzani, A. (2021). Clinical implications of malnutrition in the management of patients with pancreatic cancer: Introducing the concept of the nutritional oncology board. Nutrients, 13.","DOI":"10.3390\/nu13103522"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Mekal, D., Sobocki, J., Badowska-Kozakiewicz, A., Sygit, K., Cipora, E., Bandurska, E., Czerw, A., and Deptala, A. (2023). Evaluation of nutritional status and the impact of nutritional treatment in patients with pancreatic cancer. Cancers, 15.","DOI":"10.3390\/cancers15153816"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1007\/s00423-021-02151-7","article-title":"Impact of the controlling nutritional status score on severe postoperative complications of pancreaticoduodenectomy for pancreatic cancer","volume":"406","author":"Shiihara","year":"2021","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s12603-009-0076-z","article-title":"The effect of protein malnutrition on the capacity for protein synthesis during wound healing","volume":"13","author":"Costarelli","year":"2009","journal-title":"J. Nutr. Health Aging"},{"key":"ref_37","first-page":"j4877","article-title":"Undernutrition and severe acute malnutrition in children","volume":"359","author":"Singh","year":"2017","journal-title":"BMJ"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.21037\/gs-20-451","article-title":"Geriatric nutritional risk index serves as risk factor of surgical site infection after pancreatoduodenectomy: A validation cohort Ageo study","volume":"9","author":"Funamizu","year":"2020","journal-title":"Gland. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1089\/lap.2023.0024","article-title":"Prevalence of malnutrition and the value of predicting pancreatic fistula in patients with laparoscopic pancreatoduodenectomy","volume":"33","author":"Du","year":"2023","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.jamcollsurg.2007.02.077","article-title":"Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: A multivariate analysis of 132 patients","volume":"205","author":"Sierzega","year":"2007","journal-title":"J. Am. Coll. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Pellegrinelli, A., Mancin, S., Brolese, A., Marcucci, S., Roat, O., Morenghi, E., Morales Palomares, S., Cattani, D., Lopane, D., and Dacomi, A. (2024). Impact of preoperative malnutrition on patients with pancreatic neoplasms post-duodenopancreatectomy: A retrospective cohort study. Nutrients, 16.","DOI":"10.3390\/nu16121839"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1245\/s10434-020-08994-6","article-title":"Impact of prognostic nutritional index on postoperative pulmonary complications in radical cystectomy: A propensity score-matched analysis","volume":"28","author":"Yu","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Lee, S.C., Lee, J.G., Lee, S.H., Kim, E.Y., Chang, J., Kim, D.J., Paik, H.C., Chung, K.Y., and Jung, J.Y. (2020). Prediction of postoperative pulmonary complications using preoperative controlling nutritional status (CONUT) score in patients with resectable non-small cell lung cancer. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-68929-9"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.ccc.2011.05.004","article-title":"Nutrition therapy for ALI and ARDS","volume":"27","author":"Krzak","year":"2011","journal-title":"Crit. Care Clin."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1016\/j.clnu.2020.09.037","article-title":"Nutritional treatment is associated with longer survival in patients with pancreatic disease and concomitant risk of malnutrition","volume":"40","author":"Rivelsrud","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.clnesp.2022.01.021","article-title":"Clinical and nutritional characteristics on overall survival impact in patients with gastrointestinal cancer","volume":"48","author":"Schiessel","year":"2022","journal-title":"Clin. Nutr. ESPEN"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/655\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:32:19Z","timestamp":1759919539000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/2\/655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,20]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14020655"],"URL":"https:\/\/doi.org\/10.3390\/jcm14020655","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,20]]}}}