Nutrition screening tool predicts poor outcomes after pancreatic cancer surgery

Editor's Note

The Perioperative Nutrition Screen (PONS) identifies patients at greater risk of complications following pancreatic cancer surgery, according to a retrospective analysis published August 27 by Research Square. The study found that patients flagged for nutrition risk by PONS experienced longer hospital stays, higher complication rates, and were more likely to require discharge to facilities other than home.

Researchers analyzed 13,975 patients in the National Surgical Quality Improvement Program who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) for pancreatic cancer between 2015 and 2019. Of these, 25.7% screened positive on PONS, which assesses body mass index (BMI), recent unintentional weight loss, and serum albumin levels. Patients were matched 1:1 to account for demographic and clinical differences.

In the PD group, a positive PONS correlated with significantly higher rates of wound disruption (1.7% vs 0.7%), unplanned intubation (3.5% vs 2.1%), ventilation lasting more than 48 hours (3.3% vs 1.9%), perioperative transfusions (27.9% vs 17.3%), and septic shock (3.3% vs 1.9%). These patients also stayed in the hospital longer (10 vs 8 days on average) and were more likely to be discharged to non-home settings (17.1% vs 11.2%).

For patients undergoing DP, positive PONS status was linked to more organ/space infections (16% vs 9.9%), higher transfusion rates (21.7% vs 13.8%), greater likelihood of return to the OR (7.5% vs 3.1%), and longer hospital stays (9 vs 7 days). Discharge to other-than-home was also more frequent (15.3% vs 6.5%).

Despite the elevated complication burden, the study did not find differences in 30-day mortality. The authors note this may reflect perioperative nutrition interventions already being implemented under enhanced recovery protocols, though nutrition screening is still not routinely standardized across hospitals.

The article highlights that PONS offers a practical, nurse-executable tool for early detection of nutrition risk, which may guide perioperative planning, improve discharge coordination, and support targeted interventions such as immune-nutrition or more aggressive feeding strategies. The authors conclude that incorporating PONS into routine preoperative care for pancreatic cancer patients could help reduce preventable complications and hospital utilization.