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Unveiling the intrinsic role of malnutrition in patients with Crohn’s disease undergoing major surgery using entropy balancing weighting analysis

Published online by Cambridge University Press:  28 October 2024

Giovanni Taffurelli Open the ORCID record for Giovanni Taffurelli [Opens in a new window] ,
Isacco Montroni ,
Federico Ghignone ,
Davide Zattoni ,
Federico Mazzotti ,
Giacomo Frascaroli  and
Giampaolo Ugolini
Giovanni Taffurelli*
Affiliation:
Colorectal and General Surgery Unit, Ospedale Santa Maria delle Croci – Ravenna (AUSL Romagna), Ravenna, Italy
Isacco Montroni
Affiliation:
Colorectal and General Surgery Unit, Ospedale Santa Maria delle Croci – Ravenna (AUSL Romagna), Ravenna, Italy
Federico Ghignone
Affiliation:
Colorectal and General Surgery Unit, Ospedale Santa Maria delle Croci – Ravenna (AUSL Romagna), Ravenna, Italy
Davide Zattoni
Affiliation:
Colorectal and General Surgery Unit, Ospedale Santa Maria delle Croci – Ravenna (AUSL Romagna), Ravenna, Italy
Federico Mazzotti
Affiliation:
Colorectal and General Surgery Unit, Ospedale Santa Maria delle Croci – Ravenna (AUSL Romagna), Ravenna, Italy
Giacomo Frascaroli
Affiliation:
Colorectal and General Surgery Unit, Ospedale Santa Maria delle Croci – Ravenna (AUSL Romagna), Ravenna, Italy
Giampaolo Ugolini
Affiliation:
Colorectal and General Surgery Unit, Ospedale Santa Maria delle Croci – Ravenna (AUSL Romagna), Ravenna, Italy University of Bologna, Bologna, Italy
*
*Corresponding author: Giovanni Taffurelli; emails [email protected]; [email protected]
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Abstract

The negative role of malnutrition in patients with Crohn’s disease is known; however, many coexisting disease-related factors could cause misinterpretation of the real culprit. This study aimed to describe the role of malnutrition using a novel methodology, entropy balancing. This was a retrospective analysis of consecutive patients undergoing elective major surgery for Crohn’s disease, preoperatively screened following the European Society for Clinical Nutrition guidelines. Two-step entropy balancing was applied to the group of malnourished patients to obtain an equal cohort having a null or low risk of malnutrition. The first reweighting homogenised the cohorts for non-modifiable confounding factors. The second reweighting matched the two groups for modifiable nutritional factors, assuming successful treatment of malnutrition. The entropy balancing was evaluated using the d-value. Postoperative results are reported as mean difference or OR, with a 95 % CI. Of the 183 patients, 69 (37·7 %) were at moderate/high risk for malnutrition. The malnourished patients had lower BMI (d = 1·000), Hb (d = 0·715), serum albumin (d = 0·981), a higher lymphocyte count (d = 0·124), Charlson Comorbidity Index (d = 0·257), American Society of Anaesthesiologists (d = 0·327) and Harvey-Bradshaw scores (d = 0·696). Protective loop ileostomy was more frequently performed (d = 0·648) in the malnourished group. After the first reweighting, malnourished patients experienced a prolonged length of stay (mean difference = 1·9; 0·11, 3·71, days), higher overall complication rate (OR 4·42; 1·39, 13·97) and higher comprehensive complication index score (mean difference = 8·9; 2·2 15·7). After the second reweighting, the postoperative course of the two groups was comparable. Entropy balancing showed the independent role of preoperative malnutrition and the possible advantages obtainable from a pre-habilitation programme in Crohn’s disease patients awaiting surgery.

Keywords

MalnutritionCrohn’s diseaseEntropy balancingPostoperative outcomesPre-habilitation
Type
Research Article
Information
British Journal of Nutrition , Volume 132 , Issue 8 , 28 October 2024 , pp. 1030 - 1038
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society

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