Preoperative sleep quality predicts postoperative morbidity in elderly gastric cancer patients undergoing radical gastrectomy: integration with nutritional and sarcopenia assessment.
Patients underwent radical gastrectomy between June 2020 and June 2023
Complications were classified using the Clavien-Dindo grading system
Results
Sarcopenia and nutritional risk were prevalent in the study cohort and served as independent predictors of postoperative complication severity.
Sarcopenia was present in 30.9% of patients, defined by Asian Working Group for Sarcopenia 2019 criteria
Nutritional risk was present in 27.2% of patients, assessed by the Geriatric Nutritional Risk Index (GNRI)
Both low GNRI and sarcopenia were identified as independent predictors in multivariable regression
These factors were included alongside sleep quality in the integrated predictive models
Results
Additional independent predictors of postoperative complication severity included surgical and clinical factors beyond sleep and nutritional status.
Total gastrectomy (vs. subtotal) was an independent predictor
Open surgical approach (vs. minimally invasive) was an independent predictor
ASA physical status ≥ III was an independent predictor
Charlson Comorbidity Index ≥ 3 and stage III disease were also independent predictors
Results
Postoperative PSQI scores at day 30 also correlated with complication severity, though this finding was considered exploratory.
Per-point OR of 1.41 (95% CI 1.26–1.58) for postoperative PSQI
This association was designated exploratory due to temporal overlap between postoperative sleep measurement and complication occurrence
PSQI was measured at postoperative day 30
The postoperative PSQI OR was slightly higher than the preoperative PSQI OR (1.41 vs. 1.36)
Results
Predictive models integrating sleep, nutritional, and sarcopenia assessments demonstrated good discrimination and calibration after bootstrap validation.
AUC/c-index range of 0.74–0.79 across models
Model performance was evaluated using c-index/AUC, Brier score, and calibration
Validation was performed using 1000-bootstrap resampling
Multivariable proportional-odds and binary logistic regression were both applied
What This Means
This research suggests that how well elderly patients sleep before stomach cancer surgery may be an important indicator of how they will recover afterward. In a study of 485 patients aged 60 and older who had their stomach partially or fully removed for cancer, researchers found that worse preoperative sleep quality — measured using a standard questionnaire called the Pittsburgh Sleep Quality Index — was linked to more serious postoperative complications within 30 days. About one in three patients experienced some complication, and roughly 4% had severe complications. Poor sleep predicted worse outcomes independently of other known risk factors.
The study also found that malnutrition and sarcopenia (low muscle mass and strength, which is common in older adults and cancer patients) were present in roughly a quarter to a third of patients and were similarly associated with worse surgical outcomes. Other factors like the extent of surgery, open versus minimally invasive approach, and overall health status also mattered. When sleep quality, nutritional status, and sarcopenia assessments were combined into a single predictive model, the model performed well at identifying which patients were at higher risk for complications.
This research suggests that routinely measuring sleep quality before major cancer surgery could help doctors better identify elderly patients who might benefit from extra support before and after their operation. Sleep, nutrition, and muscle health represent potentially modifiable factors — meaning there may be opportunities to intervene prior to surgery to improve patient outcomes, though further research would be needed to confirm whether such interventions actually reduce complications.
Pan S, Wang G. (2026). Preoperative sleep quality predicts postoperative morbidity in elderly gastric cancer patients undergoing radical gastrectomy: integration with nutritional and sarcopenia assessment.. Surgical endoscopy. https://doi.org/10.1007/s00464-025-12539-x