Multidimensional prognostic value of preoperative Prognostic Nutritional Index for postoperative outcomes in older adults undergoing major open abdominal surgery.
- 1Department of Anesthesiology, PLA Rocket Force Characteristic Medical Center, Beijing, China.
Abstract
Objective
To evaluate the predictive value of the preoperative Prognostic Nutritional Index (PNI) for multidimensional postoperative outcomes in elderly patients undergoing major abdominal surgery.Methods
This single-center retrospective cohort study included 761 patients aged ≥65 years from 2015 to 2025. Patients were stratified into low-PNI (<40) and high-PNI (≥40) groups. The primary outcome was postoperative delirium within 7 days. Secondary outcomes included 90-day mortality, Clavien-Dindo classification, postoperative hospital stay, and functional recovery milestones (time to first ambulation, oral intake, and defecation). Multivariable regression models (logistic, Cox proportional hazards, and competing risk Fine-Gray models) were employed, adjusting for age, ASA grade, surgical factors, and comorbidities. PNI was further stratified into four categories (<35, 35-40, 40-45, and >45) for dose-response trend analysis.Results
Compared to the low-PNI group, the high-PNI group had a significantly lower risk of postoperative delirium (adjusted odds ratio [aOR] =0.21, 95% confidence interval [CI]:0.13-0.35, P < 0.001), 90-day mortality (adjusted hazard ratio [aHR] = 0.22, 95% CI: 0.10-0.48, P < 0.001), and severe complications (OR = 0.18, 95% CI: 0.12-0.27, P < 0.001). In the competing risk analysis, high PNI was independently associated with faster achievement of all functional recovery milestones (all subdistribution hazard ratios [SHR] >1, P < 0.001). The dose-response analysis confirmed a significant gradient effect: Each increment in PNI category was associated with progressively lower risks of adverse events and faster recovery.Conclusion
Preoperative PNI is a robust, independent predictor of multiple postoperative outcomes in elderly abdominal surgery patients. As a simple and cost-effective tool, PNI is well suited for preoperative risk stratification and guiding personalized perioperative management.
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BibTeX
@article{xing2026multidimensional,
title = {{Multidimensional prognostic value of preoperative Prognostic Nutritional Index for postoperative outcomes in older adults undergoing major open abdominal surgery.}},
author = {Ruowen Xing and Zhixiang Zhang and Xiaomeng Sun and Yuheng Ma and Hao Zhang and Guanhua Li},
journal = {Saudi journal of anaesthesia},
year = {2026},
month = oct,
doi = {10.4103/sja.sja_155_26},
url = {https://europepmc.org/article/MED/42960350},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Multidimensional prognostic value of preoperative Prognostic Nutritional Index for postoperative outcomes in older adults undergoing major open abdominal surgery.
AU - Ruowen Xing
AU - Zhixiang Zhang
AU - Xiaomeng Sun
AU - Yuheng Ma
AU - Hao Zhang
AU - Guanhua Li
PY - 2026
DA - 2026/10/01
JO - Saudi journal of anaesthesia
DO - 10.4103/sja.sja_155_26
UR - https://europepmc.org/article/MED/42960350
AB - Objective To evaluate the predictive value of the preoperative Prognostic Nutritional Index (PNI) for multidimensional postoperative outcomes in elderly patients undergoing major abdominal surgery.Methods This single-center retrospective cohort study included 761 patients aged ≥65 years from 2015 to 2025. Patients were stratified into low-PNI (<40) and high-PNI (≥40) groups. The primary outcome was postoperative delirium within 7 days. Secondary outcomes included 90-day mortality, Clavien-Dindo classification, postoperative hospital stay, and functional recovery milestones (time to first ambulation, oral intake, and defecation). Multivariable regression models (logistic, Cox proportional hazards, and competing risk Fine-Gray models) were employed, adjusting for age, ASA grade, surgical factors, and comorbidities. PNI was further stratified into four categories (<35, 35-40, 40-45, and >45) for dose-response trend analysis.Results Compared to the low-PNI group, the high-PNI group had a significantly lower risk of postoperative delirium (adjusted odds ratio [aOR] =0.21, 95% confidence interval [CI]:0.13-0.35, P < 0.001), 90-day mortality (adjusted hazard ratio [aHR] = 0.22, 95% CI: 0.10-0.48, P < 0.001), and severe complications (OR = 0.18, 95% CI: 0.12-0.27, P < 0.001). In the competing risk analysis, high PNI was independently associated with faster achievement of all functional recovery milestones (all subdistribution hazard ratios [SHR] >1, P < 0.001). The dose-response analysis confirmed a significant gradient effect: Each increment in PNI category was associated with progressively lower risks of adverse events and faster recovery.Conclusion Preoperative PNI is a robust, independent predictor of multiple postoperative outcomes in elderly abdominal surgery patients. As a simple and cost-effective tool, PNI is well suited for preoperative risk stratification and guiding personalized perioperative management.
SN - 1658-354X
SN - 0975-3125
ER -