Association of a multimodal perioperative nutritional/ERAS care pathway with postoperative infectious complications following radical hysterectomy for cervical cancer: a retrospective nonconcurrent cohort study

Abstract

Malnutrition is prevalent in women with cervical cancer and may be associated with postoperative infectious complications following radical hysterectomy. Evidence specifically evaluating structured multimodal perioperative nutritional/ERAS care in this population remains limited. We conducted a single-center retrospective nonconcurrent cohort study of 268 patients who underwent radical hysterectomy for cervical cancer (FIGO stages IA–IIB) between January 2020 and December 2024. Patients who received a structured multimodal perioperative nutritional/ERAS care pathway (NSG, n  = 134) were compared with patients receiving standard care (CG, n  = 134). Nutritional status was assessed using NRS-2002 and serial albumin, prealbumin, and CRP measurements. The primary outcome was any postoperative infectious complication within 30 days. Multivariable logistic regression was used to examine associations with infection risk. Baseline characteristics were similar in magnitude for measured variables; however, nonsignificant baseline tests were not interpreted as evidence of equivalence or successful matching. The 30-day infectious complication rate was lower in the NSG than in the CG (18.7% vs. 33.6%; unadjusted RR 0.56, 95% CI 0.36–0.85; p  = 0.005). SSI was also less frequent (6.0% vs. 14.2%; p  = 0.026), whereas the difference in UTI did not reach conventional statistical significance (8.2% vs. 15.7%; p  = 0.060). By POD 7, albumin was 39.1 ± 4.0 versus 34.2 ± 4.9 g/L, and mean LOS was 12.3 ± 4.1 versus 15.8 ± 5.6 days. In the exploratory multivariable model, pathway exposure was associated with lower adjusted odds of infectious complications (adjusted OR 0.47; 95% CI 0.26–0.85; p  = 0.013). Receipt of the structured multimodal perioperative nutritional/ERAS care pathway was associated with lower observed odds of 30-day infectious complications and shorter hospitalization. Because the study used a retrospective nonconcurrent comparison and the intervention was bundled, these findings should not be interpreted as proof that nutritional support alone caused the observed differences. Prospective comparative studies are warranted.