Association between preoperative geriatric nutritional risk index and early postoperative cognitive decline after laparoscopic cholecystectomy
- 1Department of Hepatobiliary Surgery, The Bethune International Peace Hospital , , ,
- 2Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University , , ,
Abstract
Background: Early postoperative cognitive decline (ePOCD) is a frequent complication in elderly surgical patients. The association between preoperative nutritional status and early postoperative cognitive decline remains unclear. This study investigated the relationship between preoperative Geriatric Nutritional Risk Index (GNRI) and early postoperative cognitive decline in elderly patients undergoing laparoscopic cholecystectomy.
Objective: To investigate the association between preoperative GNRI and ePOCD in older patients undergoing laparoscopic cholecystectomy, and to explore the discriminatory ability of GNRI for ePOCD and its association with postoperative inflammatory markers.
Methods: This study was a retrospective secondary analysis of a prospectively collected observational cohort. A total of 361 elderly patients who underwent laparoscopic cholecystectomy were included. Preoperative nutritional status was assessed using the GNRI. Cognitive function was evaluated before surgery and on postoperative days 1 and 2 using standardized cognitive assessments. Early postoperative cognitive decline was defined as a decrease of ≥3 points from the preoperative baseline in either the MMSE or MoCA score. Patients were categorized according to GNRI nutritional risk groups, and associations between preoperative GNRI and ePOCD were analyzed using logistic regression models.
Results: Among the 361 patients, 24 (6.6%) experienced early postoperative cognitive decline during the early postoperative period. The incidence of cognitive decline was higher on postoperative day 1 than on postoperative day 2. Patients with early postoperative cognitive decline had lower preoperative GNRI values compared with those without cognitive decline. After adjustment for potential confounding factors, lower GNRI remained associated with an increased risk of early postoperative cognitive decline. Older age was also independently associated with increased risk. Exploratory analyses demonstrated differences in perioperative inflammatory and neuronal injury-related biomarkers among GNRI groups; however, these findings require further validation.
Conclusion: Lower preoperative GNRI was associated with an increased risk of early postoperative cognitive decline in elderly patients undergoing laparoscopic cholecystectomy. GNRI may serve as a simple indicator for identifying elderly patients with increased vulnerability to early postoperative cognitive changes. Further prospective multicenter studies and interventional trials are required to determine whether improving preoperative nutritional status can modify postoperative cognitive outcomes.
Related
- Association of preoperative systemic immune-inflammation index and geriatric nutritional risk index with prolonged postoperative length of stay in older patients with hip fracture : A retrospective cohort study
- Development and Internal Validation of a Preoperative Risk Stratification Model for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis
- Association of Serum Ferritin and Cytokine Profile With Severity of Acute Cholecystitis in Patients Undergoing Laparoscopic Cholecystectomy
- Preoperative nutritional status and its association with postoperative complications and survival in patients undergoing total hip arthroplasty: a retrospective cohort analysis
- Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: Evolution, Validation, and Emerging Machine-Learning Approaches-A Scoping Review.
BibTeX
@article{fu2026association,
title = {{Association between preoperative geriatric nutritional risk index and early postoperative cognitive decline after laparoscopic cholecystectomy}},
author = {Yanlong Fu and Qiang Wei and Wenxin Shi},
journal = {Frontiers in nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1905999},
url = {https://europepmc.org/article/PMC/PMC13727398},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association between preoperative geriatric nutritional risk index and early postoperative cognitive decline after laparoscopic cholecystectomy
AU - Yanlong Fu
AU - Qiang Wei
AU - Wenxin Shi
PY - 2026
DA - 2026/10/20
JO - Frontiers in nutrition
DO - 10.3389/fnut.2026.1905999
UR - https://europepmc.org/article/PMC/PMC13727398
AB - Background: Early postoperative cognitive decline (ePOCD) is a frequent complication in elderly surgical patients. The association between preoperative nutritional status and early postoperative cognitive decline remains unclear. This study investigated the relationship between preoperative Geriatric Nutritional Risk Index (GNRI) and early postoperative cognitive decline in elderly patients undergoing laparoscopic cholecystectomy. Objective: To investigate the association between preoperative GNRI and ePOCD in older patients undergoing laparoscopic cholecystectomy, and to explore the discriminatory ability of GNRI for ePOCD and its association with postoperative inflammatory markers. Methods: This study was a retrospective secondary analysis of a prospectively collected observational cohort. A total of 361 elderly patients who underwent laparoscopic cholecystectomy were included. Preoperative nutritional status was assessed using the GNRI. Cognitive function was evaluated before surgery and on postoperative days 1 and 2 using standardized cognitive assessments. Early postoperative cognitive decline was defined as a decrease of ≥3 points from the preoperative baseline in either the MMSE or MoCA score. Patients were categorized according to GNRI nutritional risk groups, and associations between preoperative GNRI and ePOCD were analyzed using logistic regression models. Results: Among the 361 patients, 24 (6.6%) experienced early postoperative cognitive decline during the early postoperative period. The incidence of cognitive decline was higher on postoperative day 1 than on postoperative day 2. Patients with early postoperative cognitive decline had lower preoperative GNRI values compared with those without cognitive decline. After adjustment for potential confounding factors, lower GNRI remained associated with an increased risk of early postoperative cognitive decline. Older age was also independently associated with increased risk. Exploratory analyses demonstrated differences in perioperative inflammatory and neuronal injury-related biomarkers among GNRI groups; however, these findings require further validation. Conclusion: Lower preoperative GNRI was associated with an increased risk of early postoperative cognitive decline in elderly patients undergoing laparoscopic cholecystectomy. GNRI may serve as a simple indicator for identifying elderly patients with increased vulnerability to early postoperative cognitive changes. Further prospective multicenter studies and interventional trials are required to determine whether improving preoperative nutritional status can modify postoperative cognitive outcomes.
SN - 2296-861X
ER -