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Purpose <p>Postoperative infectious complications (POI) after gastrectomy remain a major concern. While bioelectrical impedance analysis (BIA) is used for nutritional assessment, the clinical relevance of the preoperative extracellular water-to-total body water ratio (ECW/TBW) remains unclear. We investigated the association between preoperative ECW/TBW and POI.</p> Methods <p>This single-center retrospective cohort study included 181 patients who underwent curative gastrectomy between November 2020 and October 2025. Preoperative ECW/TBW was measured using multifrequency BIA. The primary outcome was POI, defined as surgical site infection (SSI) and/or remote infection (RI) within 30 days. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.</p> Results <p>POI developed in 44 patients (24.3%), as SSI in 30 (16.6%) and as RI in 16 (8.8%). Multivariable analysis identified that a higher ECW/TBW was associated with POI (odds ratio [OR] per 0.01 increase, 1.68; 95% confidence interval [CI], 1.02–2.77; <i>P</i> = 0.040) and RI (OR 1.79; 95% CI, 1.00–3.21; <i>P</i> = 0.048), but not with SSI. ROC analysis showed a numerically higher AUC of ECW/TBW for predicting RI (area under the curve, 0.833) than phase angle (0.761).</p> Conclusions <p>Elevated ECW/TBW may reflect systemic physiological vulnerability associated with RI, particularly postoperative respiratory infection.</p>

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Preoperative fluid imbalance predicts remote infection after gastrectomy for gastric cancer

  • 期刊论文

  • 发表日期：

    2026年7月24日

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  • Tomohiko Yasuda,
  • Daisuke Kakinuma,
  • Issei Inoue,
  • Daichi Watanabe,
  • Komei Kuge,
  • Keisuke Minamimura,
  • Satoshi Matsumoto,
  • Yoshiharu Nakamura,
  • Akihisa Matsuda,
  • Hiroshi Yoshida

摘要

Purpose

Postoperative infectious complications (POI) after gastrectomy remain a major concern. While bioelectrical impedance analysis (BIA) is used for nutritional assessment, the clinical relevance of the preoperative extracellular water-to-total body water ratio (ECW/TBW) remains unclear. We investigated the association between preoperative ECW/TBW and POI.

Methods

This single-center retrospective cohort study included 181 patients who underwent curative gastrectomy between November 2020 and October 2025. Preoperative ECW/TBW was measured using multifrequency BIA. The primary outcome was POI, defined as surgical site infection (SSI) and/or remote infection (RI) within 30 days. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.

Results

POI developed in 44 patients (24.3%), as SSI in 30 (16.6%) and as RI in 16 (8.8%). Multivariable analysis identified that a higher ECW/TBW was associated with POI (odds ratio [OR] per 0.01 increase, 1.68; 95% confidence interval [CI], 1.02–2.77; P = 0.040) and RI (OR 1.79; 95% CI, 1.00–3.21; P = 0.048), but not with SSI. ROC analysis showed a numerically higher AUC of ECW/TBW for predicting RI (area under the curve, 0.833) than phase angle (0.761).

Conclusions

Elevated ECW/TBW may reflect systemic physiological vulnerability associated with RI, particularly postoperative respiratory infection.