Perioperative Nutrition Screen (PONS) Predicts Outcomes in Patients Undergoing Surgery for Pancreatic Cancer: A Retrospective Analysis

Background Poor nutrition is associated with poor surgical outcomes, and PONS is a validated tool that assesses preoperative nutrition risk. The American Society for Enhanced Recovery and Perioperative Quality Initiative recently recommended the Perioperative Nutrition Screen (PONS) for evaluating patients undergoing surgery. The objective of this study was to investigate the relationship between preoperative nutrition risk and short-term surgical outcomes in patients who underwent surgery for pancreatic cancer using the PONS. Methods The NSQIP database was queried for patients who underwent pancreatectomy for pancreatic cancer between 2015–2019. Patients were stratified by type of resection and were screened using PONS for preoperative nutrition risk. Patients with a positive PONS were matched 1:1 to those with a negative PONS. Postoperative short-term outcomes, including morbidity, mortality, and hospital length of stay. Results Among the 13,975 patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), 25.7% had a positive PONS. In a propensity-matched group of patients who underwent PD, a positive PONS was associated with increased rates of wound disruption, (0.7% vs 7%), unplanned intubation (2.1% vs. 3.5%), prolonged ventilation (1.9% vs. 3.3%), and perioperative transfusions (17.3% vs. 27.9%). Similarly, in a matched group of patients who underwent DP, a positive PONS was associated with increased organ/space infections (9.9% vs. 16%), perioperative transfusions (13.8% vs. 21.7%, p = 0.01), and return to the OR (3.1% vs. 7.5%). Conclusion Preoperative nutrition risk assessed using PONS is associated with adverse short-term outcomes in patients who undergo pancreatectomy for pancreatic cancer.