Background: Gastrectomy offers a curative treatment option for non-metastatic gastric cancers (GC). Unfortunately, cancer associated malnutrition is a common and potentially actionable problem in GC patients. In this nationwide study, we analyzed the impact of malnutrition on outcomes of patients undergoing gastrectomy for GC. Methods: The Nationwide inpatient Sample database (NIS) was used to identify patients who underwent gastrectomy for gastric cancer from 2012-2017 using ICD 9 and ICD 10 codes. The population was then divided into patients with or without PEM (Protein energy malnutrition) to compare their outcomes. Univariate and Multivariable logistic and linear regression models were used to analyze mortality and healthcare resource utilization. Results: Of the 6,620 patients identified, 4,607 (69.6%) patients were ≥ 60 years old and 3,972 (60%) were males. Majority were White (49.1%) followed by Asians (20.3%). 2,052 (31%) patients were malnourished. Patients with PEM had higher rates of sepsis [adjusted Odds ratio (aOR) 3.6(2.4-5.4), p =0.000], shock [aOR 2.9(1.9-4.5), p =0.000], acute kidney injury [aOR 2.1(1.5-2.9), P<0.001], ICU admissions [ aOR 1.9(1.3-2.9), p =0.001], and higher post operative mortality [aOR 2.5 (1.5-4.3), p =0.001]. Mean Length of stay was longer in PEM patients as compared to non-PEM patients (16.2 vs 9.4 days). On survival analysis, overall survival (OS) was significantly worse for patients with PEM undergoing gastrectomy [HR adj: 1.14 (p=0.04)]. A comparison of these outcomes has been detailed in the table. Conclusions: In this analysis, we highlight the importance of nutrition for gastric cancer patients undergoing gastrectomy. Ensuring adequate nutritional status prior to surgery can improve patient outcomes and decrease health care costs.

*aOR: Adjusted Odds Ratio, ^#P value<0.05(statistically significant).