Researchers reviewed 11 studies about a simple nutritional health score called GNRI that doctors can use to predict how well patients will recover from leg artery surgery. The studies showed that patients with poor nutrition (low GNRI scores) had worse outcomes after surgery, including higher death rates and more amputations. This suggests that checking a patient’s nutritional health before surgery could help doctors identify who needs extra support and might help improve results. The findings highlight why good nutrition matters for people facing leg artery procedures.

The Quick Take

  • What they studied: Whether a simple nutrition score (called GNRI) can predict how well patients recover after surgery to fix blocked leg arteries
  • Who participated: 11 different research studies involving patients with blocked leg arteries who had surgery to restore blood flow. Some had minimally invasive procedures, others had traditional open surgery
  • Key finding: Patients with low nutrition scores (poor nutritional status) had significantly worse outcomes, including higher death rates, more leg amputations, and lower chances of keeping their legs after surgery
  • What it means for you: If you need leg artery surgery, doctors might use a simple nutrition test before your operation to see if you’re at higher risk for complications. This could help your medical team prepare better support for your recovery. However, this is one tool among many that doctors use to assess risk

The Research Details

This was a systematic review, which means researchers looked at 11 different published studies about the same topic and combined what they learned. They searched two major medical databases (PubMed and Scopus) in June 2024 to find all relevant studies. They used a specific framework called PICO to make sure they were looking at the right studies—ones that studied the right patients, the right test (GNRI score), and the right outcomes (surgery results).

The researchers started with 345 papers, then carefully removed duplicates and papers that weren’t relevant. They read the titles and summaries of remaining papers and removed 320 more. They then read the full text of 25 papers and found that 11 met their strict requirements for quality and relevance. These 11 studies included different types of leg artery surgery: some looked at minimally invasive procedures, some at traditional open surgery, and some at both types.

The researchers also checked each study for bias (unfair influences that might skew results) using a standard tool called ROBINS-I. This helps readers understand how reliable the findings are.

This research approach is important because it combines information from multiple studies rather than relying on just one. When many studies point to the same conclusion, it’s stronger evidence. By looking at studies of both minimally invasive and open surgery, the researchers could see if the nutrition score matters across different types of procedures. Understanding which patients are at highest risk before surgery helps doctors make better decisions about care and potentially improve outcomes.

The researchers found moderate bias across the studies, meaning some studies had better quality than others. This is normal in systematic reviews. The fact that they used established guidelines (PRISMA) for conducting the review and a standard tool (ROBINS-I) for checking bias adds credibility. However, because the original studies varied in quality and design, readers should view these findings as helpful guidance rather than absolute proof

What the Results Show

The main finding across all 11 studies was clear: patients with low GNRI scores (indicating poor nutrition) had worse surgical outcomes than patients with higher scores. Specifically, patients with poor nutrition had higher death rates after surgery and higher rates of leg amputation. This pattern held true whether patients had minimally invasive procedures or traditional open surgery.

Patients with low nutrition scores also had lower “amputation-free survival,” which means they were more likely to either die or lose their leg within the follow-up period. This is a critical outcome because keeping the leg is often the main goal of this type of surgery. The research suggests that poor nutrition before surgery may make it harder for the body to heal and fight off complications.

The studies also indicated that the severity of the original artery disease might be worse in people with poor nutrition, and this combination makes recovery more difficult. Think of it like trying to repair a house during a storm—the damage is worse, and the conditions for repair are harder.

Beyond the main findings, the studies showed that nutritional status could help doctors identify which patients need closer monitoring and more aggressive support before and after surgery. Some studies suggested that improving nutrition before surgery might help, though this wasn’t the main focus of this review. The research also showed that the GNRI score is relatively easy to calculate using basic information (age, weight, and blood protein levels), making it practical for doctors to use in everyday clinical decisions

This systematic review builds on previous research showing that nutrition matters for surgical outcomes. However, this is one of the first comprehensive reviews specifically looking at how the GNRI score predicts results in leg artery surgery. Previous studies have used different nutrition measures, so this review helps clarify that the GNRI score specifically is useful for this patient population. The findings align with general medical knowledge that malnutrition increases surgical risks across many types of operations

The researchers noted several important limitations. First, the original 11 studies varied in quality and design, which means some were more reliable than others. Second, the review found moderate bias overall, suggesting some studies may have had flaws in how they were conducted. Third, the review didn’t include unpublished studies, which might have different results. Fourth, most studies were observational (watching what happened) rather than experimental (testing if improving nutrition actually helps), so we can’t be completely sure that poor nutrition causes worse outcomes versus just being a marker of other health problems. Finally, the studies came from different countries and healthcare systems, which might affect how the results apply to different populations

The Bottom Line

Based on this research, doctors should consider calculating GNRI scores for patients before leg artery surgery to help identify those at higher risk (moderate confidence level). Patients with low scores might benefit from extra nutritional support before surgery, though more research is needed to prove this helps. Patients should discuss their nutritional status with their surgical team before the procedure. This score should be used alongside other risk assessment tools, not as the only factor in decision-making

This research matters most for people scheduled for leg artery surgery and their doctors. It’s particularly relevant for older adults, who are more likely to have both artery disease and nutrition problems. People with chronic diseases, those who have lost weight unintentionally, or those with poor appetite should especially discuss nutrition with their doctors before surgery. This research is less directly relevant to people without planned surgery, though it reinforces the general importance of good nutrition for overall health

If a patient improves their nutrition before surgery, benefits might appear within weeks to months as the body becomes stronger. However, the main impact would likely be seen in the weeks and months after surgery, when good nutrition helps with wound healing and recovery. Long-term benefits (like keeping the leg and staying healthy) would be measured over months to years following the procedure

Want to Apply This Research?

  • Track daily protein intake (in grams) and body weight weekly. Users can log meals and the app can estimate protein content, helping them maintain adequate nutrition before and after surgery. Set a target based on their doctor’s recommendations
  • Users scheduled for leg artery surgery can use the app to set nutrition goals before their procedure, such as eating protein at each meal, taking recommended supplements, and maintaining a food diary. The app could send reminders about nutrition appointments and track progress toward pre-surgery nutrition targets
  • Create a pre-surgery nutrition checklist in the app that tracks: weekly weight, daily protein intake, supplement adherence, and appointment attendance with nutritionists. After surgery, continue tracking these metrics during recovery to monitor healing progress and identify any nutrition concerns early

This research summary is for educational purposes only and should not replace professional medical advice. The GNRI score is one tool among many that doctors use to assess surgical risk—it is not a substitute for comprehensive medical evaluation. If you have peripheral artery disease or are scheduled for leg artery surgery, discuss your nutritional status and this research with your doctor or vascular surgeon. Do not make changes to your diet or medical care based solely on this information. Always consult with qualified healthcare professionals before making health decisions