Preoperative prognostic nutritional index, opioid-sparing anesthesia, and outcomes after gynecologic cancer surgery: a retrospective cohort study
Abstract
BackgroundPreoperative prognostic nutritional index (PNI) may identify patients at increased perioperative risk, but whether PNI is associated with differences in outcomes across anesthetic strategies remains uncertain.MethodsThis retrospective cohort included 342 women undergoing surgery for ovarian, endometrial, or cervical cancer from 2019 to 2024. PNI was calculated as serum albumin (g/L) + 5 × absolute lymphocyte count (109/L); PNI < 45 was used as a prespecified pragmatic cutoff. A propofol-based total intravenous, opioid-sparing multimodal strategy, with regional or neuraxial analgesia when feasible, was compared with volatile-based anesthesia and opioid-centered analgesia. Outcomes included postoperative biomarkers, 30-day complications, return to intended oncologic therapy (RIOT) within 42 days, recurrence-free survival (RFS), and overall survival (OS). Regression models examined PNI-by-strategy interactions.ResultsPNI < 45 was present in 156/342 patients (45.6%). Within this stratum, median postoperative day 3 CRP was 79.1 vs. 92.6 mg/L, major complications occurred in 18.8% vs. 43.3%, and timely RIOT occurred in 79.1% vs. 55.4% with opioid-sparing vs. conventional anesthesia, respectively. Reported 36-month RFS estimates were 72.8% vs. 36.5%. In the cancer-type-stratified adjusted Cox model, the low-PNI term in the conventional-anesthesia reference stratum was associated with RFS (adjusted HR 2.14, 95% CI 1.31–3.48), with a nominal PNI-by-strategy interaction for RFS (interaction HR 0.46, 95% CI 0.22–0.94; p = 0.033). The interaction was not significant for OS (p = 0.837) or after changing the PNI cutoff to 44 or 46.ConclusionsLower PNI was associated with greater perioperative and oncologic risk. The observed RFS interaction is exploratory and sensitive to PNI dichotomization; residual oncologic, procedural, and calendar-era confounding precludes causal interpretation. Prospective confirmation with continuous PNI modeling and detailed cancer-specific adjustment is required.
Related
- Association of preoperative D-dimer-to-albumin ratio and prognostic nutritional index with aseptic wound complications and periprosthetic joint infection after primary total knee arthroplasty: a single-center retrospective cohort study
- Preoperative nutritional status defined by GLIM criteria and postoperative delirium in older patients receiving general anesthesia.
- Comparative Prognostic Value of the Preoperative Prognostic Nutritional Index and Gustave Roussy Immune Score After Curative-Intent Gastrectomy for Gastric Cancer.
- 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
- Multidimensional prognostic value of preoperative Prognostic Nutritional Index for postoperative outcomes in older adults undergoing major open abdominal surgery.
BibTeX
@article{yin2026preoperative,
title = {{Preoperative prognostic nutritional index, opioid-sparing anesthesia, and outcomes after gynecologic cancer surgery: a retrospective cohort study}},
author = {Danqin Yin and Kun He and Guang Wen},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1989222},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1989222},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Preoperative prognostic nutritional index, opioid-sparing anesthesia, and outcomes after gynecologic cancer surgery: a retrospective cohort study
AU - Danqin Yin
AU - Kun He
AU - Guang Wen
PY - 2026
DA - 2026/11/05
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1989222
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1989222
AB - BackgroundPreoperative prognostic nutritional index (PNI) may identify patients at increased perioperative risk, but whether PNI is associated with differences in outcomes across anesthetic strategies remains uncertain.MethodsThis retrospective cohort included 342 women undergoing surgery for ovarian, endometrial, or cervical cancer from 2019 to 2024. PNI was calculated as serum albumin (g/L) + 5 × absolute lymphocyte count (109/L); PNI < 45 was used as a prespecified pragmatic cutoff. A propofol-based total intravenous, opioid-sparing multimodal strategy, with regional or neuraxial analgesia when feasible, was compared with volatile-based anesthesia and opioid-centered analgesia. Outcomes included postoperative biomarkers, 30-day complications, return to intended oncologic therapy (RIOT) within 42 days, recurrence-free survival (RFS), and overall survival (OS). Regression models examined PNI-by-strategy interactions.ResultsPNI < 45 was present in 156/342 patients (45.6%). Within this stratum, median postoperative day 3 CRP was 79.1 vs. 92.6 mg/L, major complications occurred in 18.8% vs. 43.3%, and timely RIOT occurred in 79.1% vs. 55.4% with opioid-sparing vs. conventional anesthesia, respectively. Reported 36-month RFS estimates were 72.8% vs. 36.5%. In the cancer-type-stratified adjusted Cox model, the low-PNI term in the conventional-anesthesia reference stratum was associated with RFS (adjusted HR 2.14, 95% CI 1.31–3.48), with a nominal PNI-by-strategy interaction for RFS (interaction HR 0.46, 95% CI 0.22–0.94; p = 0.033). The interaction was not significant for OS (p = 0.837) or after changing the PNI cutoff to 44 or 46.ConclusionsLower PNI was associated with greater perioperative and oncologic risk. The observed RFS interaction is exploratory and sensitive to PNI dichotomization; residual oncologic, procedural, and calendar-era confounding precludes causal interpretation. Prospective confirmation with continuous PNI modeling and detailed cancer-specific adjustment is required.
SN - 2296-2565
ER -