This Overlooked Factor Was Linked To Higher Death Risk After Surgery
When an older loved one has surgery coming up, it's easy to get caught up in the logistics: the procedure, the hospital stay, and what recovery will look like.
But there's another piece of the preparation worth discussing: nutrition. A person's nutritional health can affect how well their body handles physical stress and heals afterward.
A new study of older surgical patients1 explored whether a simple health score could help identify people at greater risk after an operation.
About the study
Researchers analyzed health records from 25,126 adults aged 65 and older who underwent non-cardiac surgery in South Korea.
They wanted to find out whether a nutritional score could help flag patients with poorer survival odds after surgery.
The score, called the Geriatric Nutritional Risk Index (GNRI), combines two measurements: albumin levels in the blood and a person's actual weight compared with their ideal body weight.
Albumin is a protein made by the liver. Low levels can signal inadequate nutrition, but they can also be linked to inflammation, liver problems, or chronic illness.
Looking at albumin alongside body weight gives a broader picture of someone's health and nutritional status.
A low nutritional score was tied to nearly 4X higher mortality risk
Researchers used GNRI scores to divide participants into two groups.
Those scoring 98 or below were considered at higher nutritional risk, while those scoring above 98 were considered at lower risk. Of the 25,126 patients, 6,314 fell into the higher-risk group.
Within 90 days of surgery, 291 of those patients (4.61%) did not survive, compared with 58 (0.31%) of the 18,812 patients in the lower-risk group.
Even after accounting for factors such as age, existing health conditions, and other lab results, patients with scores of 98 or below had nearly four times the mortality risk in the 90 days after surgery.
The same pattern held for survival at 30 days, one year, and during the hospital stay. Generally, the lower the GNRI score, the higher the risk.
The score wasn't clearly linked to cardiovascular events, such as heart attacks or strokes. This suggests it may reflect broader health vulnerabilities rather than heart-specific risks.
Why nutrition can influence surgical recovery
Surgery puts the body under considerable stress. Recovering takes energy, protein, muscle strength, and a well-functioning immune system.
When someone isn't getting enough nutrition, they may be more vulnerable to muscle loss, weaker immune defenses, and slower tissue repair. All of these can make bouncing back after a major operation more difficult.
That said, a low GNRI score doesn't automatically mean someone is malnourished. Albumin levels can drop because of inflammation or underlying illness, even when someone is eating enough.
The score is better viewed as a general sign of health vulnerability than a standalone test for malnutrition.
There are also important limitations to consider. This was an observational study, so it cannot prove that poor nutrition directly caused the higher mortality risk.
All participants were recorded as Asian and treated at one hospital system in South Korea, so more research is needed to see whether the findings apply to other populations and health care settings.
What to discuss before surgery
This research isn't a reason to start taking supplements without medical guidance, but it does offer a couple of useful starting points for conversations with a health care team:
- Ask about nutritional health: Older adults preparing for surgery can ask whether their nutritional status has been assessed and whether additional support might help.
- Speak up about appetite or weight changes: Unintentional weight loss or a persistent drop in appetite before surgery is worth mentioning. Both can signal nutritional concerns that deserve attention.
The takeaway
A good surgical outcome involves more than what happens in the operating room.
Nutrition may help determine how well the body handles the recovery ahead, making it worth discussing before surgery, particularly for older adults.
