The association of geriatric nutritional risk and perioperative anesthesia-related adverse reactions in elderly patients with colorectal cancer-a prospective study.

[BACKGROUND] Colorectal cancer (CRC) is the most prevalent malignant tumor of the digestive tract, and it can lead to malnutrition in patients through various pathways. Research has shown that patients at nutritional risk experience more surgery-related complications and worse postoperative prognoses than those without nutritional risks. However, few studies have examined the relationship between nutritional status and perioperative anesthesia-related adverse reactions in CRC patients. In order to better prevent postoperative anesthesia-related adverse reactions in patients with CRC, this study aims to analyze the impact of the Geriatric Nutritional Risk Index (GNRI) on perioperative anesthesia-related adverse reactions in CRC patients.

[METHODS] From January 2023 to December 2024, data from 322 CRC patients admitted to the Second Affiliated Hospital of the Army Medical University were prospectively collected. All patients received radical surgery and were aged ≥65 years old. The patients were categorized into two groups: the nutritional risk group (n=142) and the control group (n=180), based on their GNRI scores. We compared the main clinical characteristics and the incidence of anesthesia-related adverse reactions between the two groups and logistic regressions were used to analyze the risk factors associated with nutritional risk and anesthesia-related adverse reactions.

[RESULTS] There was no statistical difference observed in gender, height, weight, hypertension, diabetes, hyperlipidemia, operation time, operation method, operation type, patient-controlled analgesia, tumor location, tumor cell differentiation and pathological type between the two groups (P>0.05). The incidence of anesthesia-related adverse reactions was significantly higher in the nutritional risk group compared to the control group (38.73% 17.22%, P<0.001). Age, tumor diameter, and lymph node metastasis were identified as independent risk factors for nutritional risk in CRC patients, with relative risks of 1.089 [95% confidence interval (CI): 1.043-1.137], 1.463 (95% CI: 1.273-1.682), and 3.074 (95% CI: 1.790-5.278), respectively. Furthermore, age, GNRI, operation time, type of surgery (open surgery), and patient-controlled analgesia were found to be independent risk factors for perioperative anesthesia-related adverse reactions, with relative risks of 1.131 (95% CI: 1.074-1.190), 0.970 (95% CI: 0.947-0.994), 1.022 (95% CI: 1.011-1.032), 4.375 (95% CI: 1.994-9.596), and 1.867 (95% CI: 1.049-3.324), respectively.

[CONCLUSIONS] The incidence of perioperative anesthesia-related adverse reactions in CRC patients is relatively high. Our finding shows that a low GNRI, as seen in the Control group, is independently associated with an increased number of complications during and after anesthesia for colorectal surgery.